Healthcare Provider Details

I. General information

NPI: 1265027601
Provider Name (Legal Business Name): ARIZONA COMMUNITY FIRST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2152 N ELDER AVE
HUACHUCA CITY AZ
85616-8124
US

IV. Provider business mailing address

PO BOX 5160
HUACHUCA CITY AZ
85616-5160
US

V. Phone/Fax

Practice location:
  • Phone: 520-442-8947
  • Fax:
Mailing address:
  • Phone: 520-442-8947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH NAOMI CELESTINE
Title or Position: PROGRAM DIRECTOR/OWNER
Credential:
Phone: 520-442-8947