Organization
CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA
Active
Parent organization
CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA
Other names
Merilac Lodge
Organization subpart
Yes
Provider details
NPI number
Legal business name
CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA
Authorized official
MARY ANNE BOGOSOFF (PROGRAM DIRECTOR)
(520) 770-8517
Entity
Organization
Contact information
Practice address
140 W SPEEDWAY BLVD, SUITE 130, TUCSON, AZ 85705-7686
(520) 623-0344
(520) 770-8578
Mailing address
5138 E 2ND ST, TUCSON, AZ 85711-1309
(520) 770-8517
(520) 770-8517
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
BH914
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
588973
AHCCS
AZ
Enumeration date
04/12/2010
Last updated
04/12/2010
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