Healthcare Provider Details

I. General information

NPI: 1407928351
Provider Name (Legal Business Name): WOMEN'S TRANSITION PROJECT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 O'HARA AVENUE
BISBEE AZ
85603
US

IV. Provider business mailing address

2700 S 8TH AVE
TUCSON AZ
85713-4730
US

V. Phone/Fax

Practice location:
  • Phone: 520-432-1771
  • Fax: 520-432-4703
Mailing address:
  • Phone: 520-628-3400
  • Fax: 520-628-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberBH-2640
License Number StateAZ

VIII. Authorized Official

Name: STEPHANIE OLIVER
Title or Position: CHIEF QUALITY MANAGEMENT OFFICER
Credential: CPC, RMM, ICD10CT-CM
Phone: 520-628-3400