Provider Demographics
NPI:1881896561
Name:CASA DE LOS NINOS
Entity type:Organization
Organization Name:CASA DE LOS NINOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR OF MEDICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:520-624-5600
Mailing Address - Street 1:1101 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-7467
Mailing Address - Country:US
Mailing Address - Phone:520-624-5600
Mailing Address - Fax:520-792-0009
Practice Address - Street 1:1138 N. 5TH AVE.
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705
Practice Address - Country:US
Practice Address - Phone:520-624-5600
Practice Address - Fax:520-792-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ385189251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ385189OtherAHCCCS PROVIDER #