Healthcare Provider Details

I. General information

NPI: 1750150108
Provider Name (Legal Business Name): TEMPE COMMUNITY ACTION AGENCY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 E APACHE BLVD
TEMPE AZ
85281-4863
US

IV. Provider business mailing address

1208 E BROADWAY RD STE 111
TEMPE AZ
85282-1513
US

V. Phone/Fax

Practice location:
  • Phone: 480-422-8922
  • Fax:
Mailing address:
  • Phone: 480-422-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MEGAN ELIZABETH WILSON
Title or Position: DIRECTOR OF PROGRAMS
Credential: MSW
Phone: 480-529-3956