Boys & Girls Club of Santa Cruz County, Inc.

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

License

CSA06ADHS0146 Issued in AZ

Legal business name

BOYS & GIRLS CLUB OF SANTA CRUZ COUNTY, INC.

Practice address

590 N Tyler Ave
Nogales, AZ 85621-2300

Phone

(520) 287-3733

Fax

(520) 287-3530

NPI assigned

Sep 13, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Vicki Lee Barden

Title

Executive Director

Phone

(520) 287-3733

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982709150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 N TYLER AVE",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "856212300",
            "telephone_number": "520-287-3733",
            "fax_number": "520-287-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 N TYLER AVE",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "856212300",
            "telephone_number": "520-287-3733",
            "fax_number": "520-287-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYS & GIRLS CLUB OF SANTA CRUZ COUNTY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BARDEN",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "520-287-3733",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "AZ",
            "license": "CSA06ADHS0146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "761793",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.