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General NPI Number Information
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NPI Number | 1467170282
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Entity Type | Organization
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Legal Business Name | STATE OF ARIZONA/STATE DEPT OF FINANCE
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 6051 E 34TH ST
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City | YUMA
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State | AZ
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Zip | 85365-4889
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Country | US
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Telephone | 928-247-8303
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Fax |
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Provider Business Mailing Address
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Address Line | 6051 E 34TH ST
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City | YUMA
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State | AZ
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Zip | 85365-4889
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Country | US
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Telephone | 928-247-8303
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Fax |
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Authorized Official
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Title or Position | CENTRAL BILLER
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Name | LAURIE A CHAPMAN
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Credential |
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Telephone | 480-318-0920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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