MEDICARE: PINAL HISPANIC COUNCIL

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	251S00000X	Community/Behavioral Health Agency	BH-3952	AZ
2	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OTC6037	OTHER	AZ	ADHS/BMFL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235271404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINAL HISPANIC COUNCIL

Provider Business Mailing Address
First Line	:	PO BOX 86537
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85754-6537
Country	:	US
Telephone Number	:	520-721-1887
Fax Number	:	520-721-0069

Provider Business Practice Location Address
First Line	:	107 EAST 4TH STREET
Second Line	:
City	:	ELOY
State	:	AZ
Zip	:	85131-2500
Country	:	US
Telephone Number	:	520-466-7765
Fax Number	:	520-466-4475

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	ROSE M LOPEZ
Credential	:	MBA
Telephone Number	:	520-721-1887

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	10/27/2025

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Directions to “PINAL HISPANIC COUNCIL ” Practice Location

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