Provider Demographics
NPI:1982362943
Name:CONNECTIONS SOUTHERNAZ, LLC
Entity Type:Organization
Organization Name:CONNECTIONS SOUTHERNAZ, LLC
Other - Org Name:CRC-OUTPATIENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER NETWORK MANAGMENT ASSOC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:TALAS-DENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-416-7647
Mailing Address - Street 1:2390 E CAMELBACK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3479
Mailing Address - Country:US
Mailing Address - Phone:602-416-7652
Mailing Address - Fax:
Practice Address - Street 1:2802 E DISTRICT ST FL 1
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-2081
Practice Address - Country:US
Practice Address - Phone:520-301-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC11316OtherSTATE LICENSE
AZ106201Medicaid