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General NPI Number Information
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NPI Number | 1326272642
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Entity Type | Organization
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Legal Business Name | PIA'S PLACE
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 615 W HILLSIDE AVE
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City | PRESCOTT
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State | AZ
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Zip | 86301-1936
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Country | US
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Telephone | 928-445-5081
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Fax | 928-445-0395
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Provider Business Mailing Address
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Address Line | 615 W HILLSIDE AVE
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City | PRESCOTT
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State | AZ
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Zip | 86301-1936
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Country | US
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Telephone | 928-445-5081
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Fax | 928-445-0395
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JEFFREY F PENNY
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Credential | M.D.
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Telephone | 928-445-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | BH-922
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License Number State | AZ
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