Basic Information
| Provider Information | |||||||||
| NPI: | 1922050319 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED COMMUNITY HEALTH CENTER - MARIA AUXILIADORA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1260 S CAMPBELL AVE | ||||||||
| Address2: | BUILDING 2 | ||||||||
| City: | GREEN VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856140503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204075606 | ||||||||
| FaxNumber: | 5206258504 | ||||||||
| Practice Location | |||||||||
| Address1: | 17388 W 3RD STREET | ||||||||
| Address2: | |||||||||
| City: | ARIVACA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204075500 | ||||||||
| FaxNumber: | 5204075990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 01/29/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 01/04/2007 | ||||||||
| NPIReactivationDate: | 06/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | JIMENEZ | ||||||||
| AuthorizedOfficialFirstName: | RODOLFO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5204075600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | 01/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.