Healthcare Provider Details

I. General information

NPI: 1811100720
Provider Name (Legal Business Name): OPEN INN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 NORTH GONZALES BOULEVARD
HUACHUCA CITY AZ
85616-4338
US

IV. Provider business mailing address

PO BOX 5766
TUCSON AZ
85703-0766
US

V. Phone/Fax

Practice location:
  • Phone: 520-456-1000
  • Fax: 520-456-1323
Mailing address:
  • Phone: 520-670-9040
  • Fax: 520-670-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA6
License Number StateAZ

VIII. Authorized Official

Name: MS. NANCY PANICO
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 520-670-9040