Provider Demographics
NPI:1538311527
Name:SOUTHWEST AUTISM RESEARCH AND RESOURCE CENTER
Entity type:Organization
Organization Name:SOUTHWEST AUTISM RESEARCH AND RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OPENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA-D
Authorized Official - Phone:602-340-8717
Mailing Address - Street 1:300 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-4103
Mailing Address - Country:US
Mailing Address - Phone:602-340-8717
Mailing Address - Fax:602-340-8720
Practice Address - Street 1:300 N 18TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-4103
Practice Address - Country:US
Practice Address - Phone:602-340-8717
Practice Address - Fax:602-340-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-2716251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ825557Medicaid
1689741357OtherNPI