Healthcare Provider Details

I. General information

NPI: 1033756358
Provider Name (Legal Business Name): NATIVE MUSIC COALITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W FORT LOWELL RD
TUCSON AZ
85705-3814
US

IV. Provider business mailing address

1706 E CALLE SALAMANCA
TUCSON AZ
85714-1729
US

V. Phone/Fax

Practice location:
  • Phone: 520-301-7883
  • Fax:
Mailing address:
  • Phone: 520-262-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. VINCENT M FLORES
Title or Position: DIRECTOR
Credential:
Phone: 520-301-7883