Provider Demographics
NPI:1861522435
Name:UNITED CEREBRAL PALSY OF SOUTHERN ARIZONA, INC
Entity type:Organization
Organization Name:UNITED CEREBRAL PALSY OF SOUTHERN ARIZONA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-795-3108
Mailing Address - Street 1:630 N. CRAYCROFT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711
Mailing Address - Country:US
Mailing Address - Phone:520-795-3108
Mailing Address - Fax:520-795-3196
Practice Address - Street 1:630 N CRAYCROFT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1405
Practice Address - Country:US
Practice Address - Phone:520-795-3108
Practice Address - Fax:520-795-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ329393Medicaid