NPIMap

Organization Active NPI

Codac Behavioral Health Services, Inc.

  • Community/Behavioral Health Agency
  • Tucson, AZ
National Provider Identifier
1114127602
Registry record updated Jul 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
CSA06ADHS0194 2 Issued in AZ
Legal business name
CODAC BEHAVIORAL HEALTH SERVICES, INC.
Practice address
3550 N 1St Ave
Suite 100
Tucson, AZ 85719-1770
Phone
(520) 327-4505
Fax
(520) 202-1889
NPI assigned
Jul 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2007

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

Authorized official

Name
Mr. W. Mark Clark
Title
Ceo
Phone
(520) 327-4505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X CSA06ADHS0194 2 AZ Primary

Addresses

Primary practice location

3550 N 1St Ave
Suite 100
Tucson, AZ 85719-1770

Mailing address

127 S 5TH Ave
Tucson, AZ 85701-2005
Phone (520) 327-4505

Other identifiers 1

IdentifierTypeStateIssuer
128640OtherAZAHCCCS ID

Other names 1

  • CODAC Safety Zone Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Codac Health Recovery13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

3550 N 1st Ave
Ste 100
Tucson, AZ 85719

NPI Registry JSON

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

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185148800000",
    "number": "1114127602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 S 5TH AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857012005",
            "telephone_number": "520-327-4505",
            "fax_number": "520-202-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 N 1ST AVE",
            "address_2": "SUITE 100",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857191770",
            "telephone_number": "520-327-4505",
            "fax_number": "520-202-1889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CODAC BEHAVIORAL HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-23",
        "last_updated": "2007-07-23",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "W.",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-327-4505",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "CSA06ADHS0194 2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS ID",
            "identifier": "128640",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CODAC Safety Zone",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.