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General NPI Number Information
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NPI Number | 1063504199
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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 | 09/28/2006
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | 1900 W SPEEDWAY BLVD
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City | TUCSON
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State | AZ
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Zip | 85745-2215
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Country | US
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Telephone | 520-792-0591
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Fax | 520-882-5817
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Provider Business Mailing Address
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Address Line | 504 W 29TH ST
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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 | EVP/COO
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Name | KATHY GUZMAN 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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | BH-015
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License Number State | AZ
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