| Codac 4th Avenue | |
|
721 N 4th Ave Tucson AZ 85705-8446 | |
| (520) 327-4505 | |
| (520) 202-1889 |
| Full Name | Codac 4th Avenue |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 721 N 4th Ave, Tucson, Arizona |
| Authorized Official Name and Position | W Mark Clark (CEO) |
| Authorized Official Contact | 5203274505 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Codac 4th Avenue 127 S 5th Ave Tucson AZ 85701-2005 Ph: (520) 327-4505 | Codac 4th Avenue 721 N 4th Ave Tucson AZ 85705-8446 Ph: (520) 327-4505 |
| NPI Number | 1033319751 |
|---|---|
| Provider Enumeration Date | 07/20/2007 |
| Last Update Date | 02/15/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033319751 | NPI | - | NPPES |
| 255732 | Medicaid | AZ | |
| BH-2954 | Other | AZ | ADHS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | () | Primary |
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