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General NPI Number Information
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NPI Number | 1023119955
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Entity Type | Organization
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Legal Business Name | LA FRONTERA CENTER, INC.
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1441 S. NO LE HACE
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City | TUCSON
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State | AZ
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Zip | 85745
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Country | US
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Telephone | 520-622-5805
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Fax | 520-622-5981
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Provider Business Mailing Address
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Address Line | 502 W. 29TH STREET
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City | TUCSON
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State | AZ
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Zip | 85713-3353
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Country | US
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Telephone | 520-884-9920
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Fax | 520-792-0654
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Authorized Official
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Title or Position | COO
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Name | MS. KATHY WELLS
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Credential |
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Telephone | 520-838-5501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | BH-1520
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License Number State | AZ
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