Organization
ST JOHNS CONCHO SENIOR CITIZENS ASSOC
Active
Organization
ST JOHNS CONCHO SENIOR CITIZENS ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETTY JO CLANTON MEMBER OF SENIOR BRD (PRESIDENT)
(928) 337-2144
Entity
Organization
Contact information
Practice address
395 SOUTH FIRST WEST ST, ST JOHNS CONCHO SENIOR CITIZENS ASSOC, ST JOHNS, AZ 85936-0887
(928) 337-2144
(928) 337-2581
Mailing address
PO BOX 887, ST JOHNS, AZ 85936-0887
(928) 337-2144
(928) 337-2581
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
P0496
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
351560
AHCCCS
—
Enumeration date
03/13/2008
Last updated
03/13/2008
Update your record
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