MEDICARE: ORIGINS SOCIETY AND GLOBAL COLLEGE

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	06176	AZ

General Provider Information

NPI Number	:	1851681118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORIGINS SOCIETY AND GLOBAL COLLEGE

Provider Business Mailing Address
First Line	:	2555 N EDITH BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-2508
Country	:	US
Telephone Number	:	520-881-1344
Fax Number	:	520-203-8227

Provider Business Practice Location Address
First Line	:	2555 N EDITH BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-2508
Country	:	US
Telephone Number	:	520-881-1344
Fax Number	:	520-203-8227

Authorized Official
Title or Position	:	CEO
Name	:	DR. JAMES S. GITTINGS
Credential	:	PH.D
Telephone Number	:	520-400-0987

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	04/07/2011

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