MEDICARE: THE PRIMAVERA FOUNDATION INC

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1275464018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PRIMAVERA FOUNDATION INC

Provider Business Mailing Address
First Line	:	151 W 40TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-3994
Country	:	US
Telephone Number	:	520-308-3053
Fax Number	:	520-308-3053

Provider Business Practice Location Address
First Line	:	151 W 40TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-3994
Country	:	US
Telephone Number	:	520-308-3053
Fax Number	:	520-308-3053

Authorized Official
Title or Position	:	CHIEF COMPLIANCE AND IT OFFICER
Name	:	CAMMIE DIRRIM
Credential	:
Telephone Number	:	520-308-3053

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “THE PRIMAVERA FOUNDATION INC ” Practice Location

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