Healthcare Provider Details

I. General information

NPI: 1962982397
Provider Name (Legal Business Name): ESCALERA HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 N CRAYCROFT RD STE 100
TUCSON AZ
85712-2811
US

IV. Provider business mailing address

2850 NORTH COUNTRY CLUB ROAD
TUCSON AZ
85716-1910
US

V. Phone/Fax

Practice location:
  • Phone: 520-209-1919
  • Fax: 520-207-6200
Mailing address:
  • Phone: 520-322-6274
  • Fax: 520-509-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberOTC9032
License Number StateAZ

VIII. Authorized Official

Name: MR. EDWARD J HUDSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 520-322-6274