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General NPI Number Information
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NPI Number | 1093315129
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Entity Type | Organization
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Legal Business Name | PARKER COMMUNITY SENIOR CENTER
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 1115 W 12TH ST
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City | PARKER
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State | AZ
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Zip | 85344-5711
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Country | US
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Telephone | 928-669-9514
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Fax | 928-669-0179
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Provider Business Mailing Address
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Address Line | 1115 W 12TH ST
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City | PARKER
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State | AZ
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Zip | 85344-5711
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Country | US
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Telephone | 928-669-9514
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Fax | 928-669-0179
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Authorized Official
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Title or Position | DIRECTOR
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Name | DARLA K TILLEY
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Credential |
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Telephone | 928-669-9514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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