Basic Information
| Provider Information | |||||||||
| NPI: | 1720416365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROVIDENCE SERVICES CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1161 N EL DORADO PL | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857154607 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1161 N EL DORADO PL | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857154607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207487108 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2013 | ||||||||
| LastUpdateDate: | 10/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | PATTON | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | C.E. O. | ||||||||
| AuthorizedOfficialTelephone: | 5207487108 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | BH3625 | AZ | Y | Agencies | Community/Behavioral Health |
No ID Information.