Healthcare Provider Details

I. General information

NPI: 1982673992
Provider Name (Legal Business Name): UNITED CEREBRAL PALSY ASSOCIATION OF CENTRAL ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/13/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 W PARKSIDE LN
PHOENIX AZ
85027-1322
US

IV. Provider business mailing address

1802 W PARKSIDE LN
PHOENIX AZ
85027-1322
US

V. Phone/Fax

Practice location:
  • Phone: 602-943-5472
  • Fax: 602-943-4936
Mailing address:
  • Phone: 602-943-5472
  • Fax: 602-943-4936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateAZ
# 9
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateAZ

VIII. Authorized Official

Name: KENTAY GARVIN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 602-943-5472