Organization
PROVIDENCE OF ARIZONA, INC.
Active
Other names
Providencia
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID HEDGCOCK M.ED (EXECUTIVE DIRECTOR)
(602) 455-4626
Entity
Organization
Contact information
Practice address
3602 W THOMAS RD, PHOENIX, AZ 85019-4442
(602) 455-4626
(602) 455-4624
Mailing address
620 N CRAYCROFT RD, TUCSON, AZ 85711-1448
(520) 747-6676
(520) 747-6605
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
BH-2200
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
796021
—
AZ
Enumeration date
09/22/2006
Last updated
08/22/2020
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