Organization
EASTER SEALS BLAKE FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISSA S ARENDT (CFO)
(520) 327-1529
Entity
Organization
Contact information
Practice address
7750 E BROADWAY BLVD STE A100, TUCSON, AZ 85710-3901
(520) 327-1529
Mailing address
7750 E BROADWAY BLVD STE A100, TUCSON, AZ 85710-3901
(520) 327-1529
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
OTC8370
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC8370
FACILITIES LICENSE ADHS
AZ
Enumeration date
06/30/2017
Last updated
08/03/2021
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