Organization
MENLO HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELIZABETH MARY FORD (ADMINISTRATOR)
(520) 628-8251
Entity
Organization
Contact information
Practice address
1323 W PLACITA PLATA, TUCSON, AZ 85745-2722
(520) 628-8251
(520) 207-6369
Mailing address
1323 W PLACITA PLATA, TUCSON, AZ 85745-2722
(520) 628-8251
(520) 207-6369
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
BH2111
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
728967
AHCCCS
AR
Enumeration date
09/20/2006
Last updated
08/22/2020
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