Provider Demographics
NPI:1588952089
Name:CRISIS RESPONSE NETWORK OF SOUTHERN ARIZONA, INC.
Entity type:Organization
Organization Name:CRISIS RESPONSE NETWORK OF SOUTHERN ARIZONA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RABIDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-427-4603
Mailing Address - Street 1:2802 EAST DISTRICT STREET
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714
Mailing Address - Country:US
Mailing Address - Phone:520-284-3508
Mailing Address - Fax:
Practice Address - Street 1:2802 EAST DISTRICT STREET
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714
Practice Address - Country:US
Practice Address - Phone:520-284-3508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRISIS RESPONSE NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3870251S00000X, 261QM0850X, 261QM0855X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health