Healthcare Provider Details

I. General information

NPI: 1619279155
Provider Name (Legal Business Name): COMMUNITY PARTNERS INTEGRATED HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 4TH ST STE. A & B
SAFFORD AZ
85546-2074
US

IV. Provider business mailing address

PO BOX 86537
TUCSON AZ
85754-6537
US

V. Phone/Fax

Practice location:
  • Phone: 928-792-4242
  • Fax: 928-428-3885
Mailing address:
  • Phone: 520-721-1887
  • Fax: 520-721-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberOTC8052
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ROSE MARY LOPEZ
Title or Position: PRESIDENT AND CEO
Credential: MBA
Phone: 520-721-1887