Organization
EASTER SEALS BLAKE FOUNDATION
Active
Other names
Blake Foundation
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARISSA S ARENDT (CFO)
(520) 327-1529
Entity
Organization
Contact information
Practice address
55 S 5TH ST, SIERRA VISTA, AZ 85635-1857
(520) 452-9784
Mailing address
7750 E BROADWAY BLVD, STE. A200, TUCSON, AZ 85710-3901
(520) 327-1529
(520) 327-1836
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
OTC6905
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC6905
ADHS LICENSE
AZ
Enumeration date
11/12/2008
Last updated
09/01/2023
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