| Jewish Family And Children's Service Of Southern Arizona, Inc | |
|
4301 East 5th Street Tucson AZ 85711-2005 | |
| (520) 795-0300 | |
| (520) 795-8206 |
| Full Name | Jewish Family And Children's Service Of Southern Arizona, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4301 East 5th Street, Tucson, Arizona |
| Authorized Official Name and Position | Carlos Hernandez (CEO) |
| Authorized Official Contact | 5207950300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jewish Family And Children's Service Of Southern Arizona, Inc 4301 East 5th Street Tucson AZ 85711-2005 Ph: (520) 795-0300 | Jewish Family And Children's Service Of Southern Arizona, Inc 4301 East 5th Street Tucson AZ 85711-2005 Ph: (520) 795-0300 |
| NPI Number | 1093876542 |
|---|---|
| Provider Enumeration Date | 12/12/2006 |
| Last Update Date | 12/06/2022 |
| Certification Date | 12/06/2022 |
| Medicare PECOS PAC ID | 9436176831 |
|---|---|
| Medicare Enrollment ID | O20051025000775 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093876542 | NPI | - | NPPES |
| 116865 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | BH1600 (Arizona) | Secondary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | BH213 (Arizona) | Primary |
| Provider Name | Georgia C Fitzsimmons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104852763 PECOS PAC ID: 5799000535 Enrollment ID: I20150219000180 |
| Provider Name | Dorothy A Bowring |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518192863 PECOS PAC ID: 9335284504 Enrollment ID: I20171011001832 |
| Provider Name | Mary Martin Hayden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710698642 PECOS PAC ID: 8820463458 Enrollment ID: I20230412001252 |
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