| Pinal Hispanic Council | |
|
1940 E 11th St Douglas AZ 85607-2413 | |
| (520) 466-7765 | |
| (520) 466-4475 |
| Full Name | Pinal Hispanic Council |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1940 E 11th St, Douglas, Arizona |
| Authorized Official Name and Position | Ralph Varela (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5204667765 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pinal Hispanic Council Po Box 86537 Tucson AZ 85754-6537 Ph: (520) 721-1887 | Pinal Hispanic Council 1940 E 11th St Douglas AZ 85607-2413 Ph: (520) 466-7765 |
| NPI Number | 1588966717 |
|---|---|
| Provider Enumeration Date | 11/19/2010 |
| Last Update Date | 01/03/2020 |
| Certification Date | 01/03/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588966717 | NPI | - | NPPES |
| BH3766 | Other | AZ | OBHL LICENSE |
| OTC6065 | Other | AZ | ADHS/BMFL LICENSE |
| 598482 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | BH3766 (Arizona) | Primary |
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