Regina Heaton Finicum

Individual provider Active NPI Foster Care Agency · Fredonia, AZ

NPI 1194201814 · NPPES record last updated Jul 16, 2018

Key facts

NPI
1194201814
Entity type
Individual (NPI type 1)
Primary specialty
Foster Care Agency 253J00000X
License
368267 (AZ)
Practice address
2800 N. 50 E.
Fredonia, AZ 86022
Phone
(435) 689-9787
NPI assigned
Jul 16, 2018
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
368267AZMDFoster Care Agency

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Foster Care Agency 253J00000X 368267 AZ Yes

Addresses

Primary practice location

2800 N. 50 E.
Fredonia, AZ 86022

Mailing address

PO Box 528
Fredonia, AZ 86022-0528
Phone (435) 689-9787

Other providers in Fredonia, AZ

All providers in Fredonia, AZ · Foster Care Agency in Arizona

Sources for this page

Verify at the official NPI Registry.