Codac At Broadway | |
3130 E Broadway Blvd Tucson AZ 85716-5863 | |
(520) 327-4505 | |
(520) 202-1889 |
Full Name | Codac At Broadway |
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Speciality | Clinic/center - Adult Mental Health |
Location | 3130 E Broadway Blvd, Tucson, Arizona |
Authorized Official Name and Position | Dennis Regnier (CEO) |
Authorized Official Contact | 5203274505 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Codac At Broadway 1650 E Fort Lowell Rd Ste 202 Tucson AZ 85719-2374 Ph: (520) 327-4505 | Codac At Broadway 3130 E Broadway Blvd Tucson AZ 85716-5863 Ph: (520) 327-4505 |
NPI Number | 1801207642 |
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Provider Enumeration Date | 05/14/2014 |
Last Update Date | 09/25/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1801207642 | NPI | - | NPPES |
968685 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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