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General NPI Number Information
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NPI Number | 1093876542
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Entity Type | Organization
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Legal Business Name | JEWISH FAMILY AND CHILDREN'S SERVICE OF SOUTHERN ARIZONA, INC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 4301 EAST 5TH STREET
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City | TUCSON
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State | AZ
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Zip | 85711-2005
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Country | US
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Telephone | 520-795-0300
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Fax | 520-795-8206
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Provider Business Mailing Address
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Address Line | 4301 EAST 5TH STREET
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City | TUCSON
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State | AZ
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Zip | 85711-2005
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Country | US
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Telephone | 520-795-0300
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Fax | 520-795-8206
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Authorized Official
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Title or Position | CEO
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Name | CARLOS HERNANDEZ
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Credential |
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Telephone | 520-795-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | BH1600
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | BH213
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License Number State | AZ
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