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Organization
PROVIDENCE OF ARIZONA, INC.
Active
Organization
PROVIDENCE OF ARIZONA, INC.
Active
Other names
Providencia
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID HEDGCOCK M.ED (EXECUTIVE DIRECTOR)
(602) 455-4626
Entity
Organization
Contact information
Practice address
3602 W THOMAS RD, PHOENIX, AZ 85019-4442
(602) 455-4626
(602) 455-4624
Mailing address
620 N CRAYCROFT RD, TUCSON, AZ 85711-1448
(520) 747-6676
(520) 747-6605
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
BH-2200
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
796021
—
AZ
Enumeration date
09/22/2006
Last updated
08/22/2020
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