MEDICARE: AMERICAN INDIAN PREVENTION COALITION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3245S0500X	Children's Substance Abuse Rehabilitation Facility		AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114141918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN INDIAN PREVENTION COALITION

Provider Business Mailing Address
First Line	:	PO BOX 25047
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85002-5047
Country	:	US
Telephone Number	:	602-424-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1622 N 27TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-3610
Country	:	US
Telephone Number	:	602-424-1600
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BONNY BEACH
Credential	:
Telephone Number	:	602-424-1600

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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