Organization
BETHEL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KOFFI SEDDO (ADMINISTRATOR PROVIDER)
(520) 891-0081
Entity
Organization
Contact information
Practice address
9820 E PASEO SAN BERNARDO, TUCSON, AZ 85747-5022
(520) 891-0081
Mailing address
9820 E PASEO SAN BERNARDO, TUCSON, AZ 85747-5022
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH-4113
AZ
Other
Enumeration date
12/18/2012
Last updated
12/18/2012
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