Boys & Girls Club of Bisbee,Az,Inc

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

BOYS & GIRLS CLUB OF BISBEE,AZ,INC

Practice address

405 Arizona St
Bisbee, AZ 85603-1503

Phone

(520) 432-3010

Fax

(520) 432-6903

NPI assigned

Sep 14, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Annette Renteria

Title

Executive Director

Phone

(520) 432-3010

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982709770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 ARIZONA ST",
            "city": "BISBEE",
            "state": "AZ",
            "postal_code": "85603",
            "telephone_number": "520-432-3010",
            "fax_number": "520-432-6903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 ARIZONA ST",
            "city": "BISBEE",
            "state": "AZ",
            "postal_code": "856031503",
            "telephone_number": "520-432-3010",
            "fax_number": "520-432-6903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYS & GIRLS CLUB OF BISBEE,AZ,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RENTERIA",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "520-432-3010",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bisbee Hospital Association
• Bisbee Hospital Association (Copper Queen Medical Associates Bisbee)
• Bisbee Hospital Association Dba CQCH
• Bisbee Unified School District
• Pamela Rose Blunt, LCSW
• Brave Path Counseling PLLC
• Julia M Brown, M.D.
• Ernestina S Buck, PHD
• Shadd Nathan Cabalatungan, M.D.
• Phyllis Cavanaugh, D.C.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Bisbee, AZ
• Providers in Bisbee, AZ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Arizona

• 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.