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Organization

EASTER SEALS BLAKE FOUNDATION

Active
Other names
Blake Foundation
Organization subpart
No

Provider details

NPI number
Authorized official
MARISSA S ARENDT (CFO)
(520) 327-1529
Entity
Organization

Contact information

Practice address
7756 E BROADWAY BLVD STE C100, TUCSON, AZ 85710-4022
(520) 327-1529
(520) 514-9878
Mailing address
7756 E BROADWAY BLVD STE A100, TUCSON, AZ 85710-4022
(520) 449-8555
(520) 204-6808

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
251S00000X
Community/Behavioral Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
885160
AHCCCS PROVIDER
AZ
05
885160
AZ
01
OTC-6111
AZ DEPT OF HEALTH SERVICES LICENSE
AZ
Enumeration date
12/04/2013
Last updated
02/22/2024
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