Provider Demographics
NPI:1730224379
Name:HOLBROOK SENIOR CITIZENS ASSOCIATION
Entity type:Organization
Organization Name:HOLBROOK SENIOR CITIZENS ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GABALDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-524-6044
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025-0580
Mailing Address - Country:US
Mailing Address - Phone:928-524-6044
Mailing Address - Fax:928-524-3603
Practice Address - Street 1:216 JOY NEVIN AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025-2924
Practice Address - Country:US
Practice Address - Phone:928-524-6044
Practice Address - Fax:928-524-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ111261OtherAHCCCS