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2039 E Wilcox Dr Suite A & B Sierra Vista AZ 85635-2781 | |
| (520) 226-9002 | |
| (520) 459-0563 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2039 E Wilcox Dr, Sierra Vista, Arizona |
| Authorized Official Name and Position | Rose Mary Lopez (PRESIDENT AND CEO) |
| Authorized Official Contact | 5207211887 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 86537 Tucson AZ 85754-6537 Ph: (520) 721-1887 | 2039 E Wilcox Dr Suite A & B Sierra Vista AZ 85635-2781 Ph: (520) 226-9002 |
| NPI Number | 1659674984 |
|---|---|
| Provider Enumeration Date | 12/08/2010 |
| Last Update Date | 04/20/2020 |
| Certification Date | 04/20/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659674984 | NPI | - | NPPES |
| 231924 | Medicaid | AZ | |
| OTC8054 | Other | AZ | BUREAU OF MEDICAL FACILITIES LICENSING |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | OTC8054 (Arizona) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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