Healthcare Provider Details

I. General information

NPI: 1972033793
Provider Name (Legal Business Name): PIMA PREVENTION PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 N STONE AVE BLDG 2
TUCSON AZ
85705-7338
US

IV. Provider business mailing address

1477 W COMMERCE CT
TUCSON AZ
85746-6016
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-3293
  • Fax: 520-792-4336
Mailing address:
  • Phone: 520-792-3293
  • Fax: 520-792-4336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier274453
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name: MR. RODNEY COOK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 520-792-3293