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General NPI Number Information
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NPI Number | 1114129467
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Entity Type | Organization
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Legal Business Name | COBRA COMPANY OF ARIZONA, INC.
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 17224 N 43RD AVE 109
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City | GLENDALE
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State | AZ
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Zip | 85308-4025
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Country | US
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Telephone | 602-978-6010
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Fax | 602-938-1209
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Provider Business Mailing Address
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Address Line | PO BOX 11779
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City | GLENDALE
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State | AZ
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Zip | 85318-1779
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Country | US
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Telephone | 602-978-6010
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Fax | 602-938-1209
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. JAMES ELDON LAWSON
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Credential |
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Telephone | 602-978-6010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 1002718
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License Number State | AZ
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