Healthcare Provider Details

I. General information

NPI: 1275464018
Provider Name (Legal Business Name): THE PRIMAVERA FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W 40TH ST
TUCSON AZ
85713-3994
US

IV. Provider business mailing address

151 W 40TH ST
TUCSON AZ
85713-3994
US

V. Phone/Fax

Practice location:
  • Phone: 520-308-3053
  • Fax: 520-308-3053
Mailing address:
  • Phone: 520-308-3053
  • Fax: 520-308-3053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: CAMMIE DIRRIM
Title or Position: CHIEF COMPLIANCE AND IT OFFICER
Credential:
Phone: 520-308-3053