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
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