Provider Demographics
NPI:1528483179
Name:ASSIST TO INDEPENDENCE
Entity type:Organization
Organization Name:ASSIST TO INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES-NOLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-283-6261
Mailing Address - Street 1:PO BOX 4133
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-4133
Mailing Address - Country:US
Mailing Address - Phone:928-283-6261
Mailing Address - Fax:928-283-6284
Practice Address - Street 1:4133 EAST CEDAR AVE
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-4133
Practice Address - Country:US
Practice Address - Phone:928-283-6261
Practice Address - Fax:928-283-6284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ459512332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ459512OtherAHCCCS PROVIDER ID NUMBER