Healthcare Provider Details

I. General information

NPI: 1720177348
Provider Name (Legal Business Name): LA FRONTERA CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10845 N THORNYDALE RD
TUCSON AZ
85742-8154
US

IV. Provider business mailing address

504 W 29TH ST
TUCSON AZ
85713-3353
US

V. Phone/Fax

Practice location:
  • Phone: 520-579-8786
  • Fax: 520-579-8794
Mailing address:
  • Phone: 520-884-9920
  • Fax: 520-792-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberBH-2168
License Number StateAZ

VIII. Authorized Official

Name: MS. KATHY WELLS
Title or Position: COO
Credential:
Phone: 520-838-5501