Provider Demographics
NPI:1780895102
Name:CATHOLIC COMMUNITY SERVICES OF SO. AZ. INC.
Entity type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICES OF SO. AZ. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-539-1263
Mailing Address - Street 1:268 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-6534
Mailing Address - Country:US
Mailing Address - Phone:520-792-1906
Mailing Address - Fax:520-770-8562
Practice Address - Street 1:268 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-6534
Practice Address - Country:US
Practice Address - Phone:520-792-1906
Practice Address - Fax:520-770-8562
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-25
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities