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NPI Code Detail

MEDICARE: EASTER SEALS BLAKE FOUNDATION

MEDICARE: EASTER SEALS BLAKE FOUNDATION
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
1251B00000XCase Management Agency
2251S00000XCommunity/Behavioral Health AgencyBH-4277AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OTC20104OTHERAZADHS

General Provider Information

NPI Number : 1528400538
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTER SEALS BLAKE FOUNDATION
Provider Business Mailing Address
First Line : 7750 E BROADWAY BLVD STE A200
Second Line :
City : TUCSON
State : AZ
Zip : 85710-3903
Country : US
Telephone Number : 520-327-1529
Fax Number : 520-327-1836
Provider Business Practice Location Address
First Line : 900 E FLORENCE BLVD STE A
Second Line :
City : CASA GRANDE
State : AZ
Zip : 85122-4673
Country : US
Telephone Number : 520-723-4429
Fax Number :
Authorized Official
Title or Position : CFO
Name : MARISSA S ARENDT
Credential :
Telephone Number : 520-327-1529
Provider Enumeration Date : 07/19/2013
Last Update Date : 10/07/2025

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Directions to “EASTER SEALS BLAKE FOUNDATION ” Practice Location

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