Provider Demographics
NPI:1952571523
Name:GILA COUNTY ASSOC. RETARDED CITIZENS
Entity type:Organization
Organization Name:GILA COUNTY ASSOC. RETARDED CITIZENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-425-6053
Mailing Address - Street 1:PO BOX 1262
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85502-1262
Mailing Address - Country:US
Mailing Address - Phone:928-425-6053
Mailing Address - Fax:928-425-0526
Practice Address - Street 1:14873 SOUTH HIGHWAY 188
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85502
Practice Address - Country:US
Practice Address - Phone:928-425-4516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ680597OtherAHCCCS