NPIMap

Organization Active NPI

Jewish Family and Children's Service of Southern Arizona, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tucson, AZ
National Provider Identifier
1093876542
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
BH213 Issued in AZ
Legal business name
JEWISH FAMILY AND CHILDREN'S SERVICE OF SOUTHERN ARIZONA, INC
Practice address
4301 East 5TH Street
Tucson, AZ 85711-2005
Phone
(520) 795-0300
Fax
(520) 795-8206
NPI assigned
Dec 12, 2006
Last updated
Dec 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carlos HernandezNPI 1497165047
Title
Ceo
Phone
(520) 795-0300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X BH213 AZ Primary
Social Worker 104100000X BH1600 AZ

Addresses

Primary practice location

4301 East 5TH Street
Tucson, AZ 85711-2005

Mailing address

4301 East 5TH Street
Tucson, AZ 85711-2005
Phone (520) 795-0300

Other identifiers 1

IdentifierTypeStateIssuer
116865MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051025000775 AZ Part B Supplier - Clinic/Group Practice 9436176831 Receives reassigned benefits from 9 practitioners
Practice locations: Tucson, AZ

National Provider Directory

National Provider Directory
Tax ID family
Jewish Family and Children's Service of Southern Arizona Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1200 N El Dorado Pl
Tucson, AZ 85715
Phone (520) 526-0050

2292 W Magee Rd
#J
Tucson, AZ 85742
Phone (520) 795-0300

2329 E Ajo Way
Tucson, AZ 85713
Phone (520) 724-2114

4301 E 5th St
Tucson, AZ 85711
Phone (520) 795-0300

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670284800000",
    "number": "1093876542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 EAST 5TH STREET",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857112005",
            "telephone_number": "520-795-0300",
            "fax_number": "520-795-8206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 EAST 5TH STREET",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857112005",
            "telephone_number": "520-795-0300",
            "fax_number": "520-795-8206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEWISH FAMILY AND CHILDREN'S SERVICE OF SOUTHERN ARIZONA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-795-0300"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "AZ",
            "license": "BH213",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AZ",
            "license": "BH1600",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116865",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.