Organization
ASSIST TO INDEPENDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LORRAINE JONES-NOLINE (EXECUTIVE DIRECTOR)
(928) 283-6261
Entity
Organization
Contact information
Practice address
4133 EAST CEDAR AVE, TUBA CITY, AZ 86045-4133
(928) 283-6261
(928) 283-6284
Mailing address
PO BOX 4133, TUBA CITY, AZ 86045-4133
(928) 283-6261
(928) 283-6284
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
459512
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
459512
AHCCCS PROVIDER ID NUMBER
AZ
Enumeration date
02/19/2014
Last updated
02/19/2014
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