COMMUNITY LIVING PROGRAM
Complete NPI Record 1780895102
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Tucson, AZ
Active since May 25, 2007
Complete NPI Dataset
This page contains the complete raw NPPES record for Community Living Program (NPI 1780895102), a community based residential treatment facility, intellectual and/or developmental disabilities organization in Tucson, AZ. All 33 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1780895102 Field 1/33
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/33
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/33
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: CATHOLIC COMMUNITY SERVICES OF SO. AZ. INC. Field 4/33
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: COMMUNITY LIVING PROGRAM Field 5/33
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 3 Field 6/33
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 268 W ADAMS ST Field 7/33
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: TUCSON Field 8/33
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: AZ Field 9/33
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 857056534 Field 10/33
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/33
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 5207921906 Field 12/33
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 5207708562 Field 13/33
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 268 W ADAMS ST Field 14/33
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: TUCSON Field 15/33
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: AZ Field 16/33
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 857056534 Field 17/33
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/33
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 5207921906 Field 19/33
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 5207708562 Field 20/33
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: JOHNSON Field 23/33
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: KARMEN Field 24/33
- The first name of the authorized official.
- Authorized Official Title or Position: ASSOCIATE DIRECTOR Field 25/33
- The title or position of the authorized official.
- Authorized Official Telephone Number: 5205391263 Field 26/33
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 320900000X Field 27/33
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number State Code 1: AZ Field 28/33
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 29/33
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: Y Field 30/33
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Parent Organization LBN: CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA, INC. Field 31/33
- The Legal Business Name (LBN) of the parent organization, if the provider is a subpart of a larger entity. This field identifies the official registered name of the parent company or organization under which the provider operates.
- Parent Organization TIN: Not available Field 32/33
- The Taxpayer Identification Number (TIN) of the parent organization, provided when the provider is a subpart of a larger entity. This field identifies the federal tax ID used by the parent organization for official and billing purposes.
Secondary Practice Locations 19
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
7015 E Redbud Rd
Location 1/19Tucson, AZ 85715-5345 · Phone (520) 623-0344 · Fax (520) 770-8514
8840 E 22nd St Apt 1
Location 2/19Tucson, AZ 85710-7330 · Phone (520) 623-0344
8840 E 22nd St Apt 2
Location 3/19Tucson, AZ 85710-7330 · Phone (520) 623-0344
5138 E 2nd St
Location 4/19Tucson, AZ 85711-1309 · Phone (520) 623-0344
3544 E 5th St
Location 5/19Tucson, AZ 85716-5012 · Phone (520) 623-0344
2345 N Craycroft Rd Apt 220
Location 6/19Tucson, AZ 85712-2812 · Phone (520) 623-0344
2345 N Craycroft Rd Apt 166
Location 7/19Tucson, AZ 85712-2862 · Phone (520) 623-0344
2345 N Craycroft Rd Apt 104
Location 8/19Tucson, AZ 85712-2813 · Phone (520) 623-0344
2345 N Craycroft Rd Apt 108
Location 9/19Tucson, AZ 85712-2814 · Phone (520) 623-0344
2345 N Craycroft Rd Apt 109
Location 10/19Tucson, AZ 85712-2815 · Phone (520) 623-0344
4175 E Fort Lowell Rd Apt 3124
Location 11/19Tucson, AZ 85712-1080 · Phone (520) 623-0344
4175 E Fort Lowell Rd Apt 3117
Location 12/19Tucson, AZ 85712-1080 · Phone (520) 623-0344
4175 E Fort Lowell Rd Apt 2109
Location 13/19Tucson, AZ 85712-1065 · Phone (520) 623-0344
4175 E Fort Lowell Rd Apt 2112
Location 14/19Tucson, AZ 85712-1065 · Phone (520) 623-0344
4175 E Fort Lowell Rd Apt 2115
Location 15/19Tucson, AZ 85712-1065 · Phone (520) 623-0344
4175 E Fort Lowell Rd Apt 3118
Location 16/19Tucson, AZ 85712-1080 · Phone (520) 623-0344
4175 E Fort Lowell Rd Apt 3119
Location 17/19Tucson, AZ 85712-1080 · Phone (520) 623-0344
4175 E Fort Lowell Rd Apt 3120
Location 18/19Tucson, AZ 85712-1080 · Phone (520) 623-0344
4175 E Fort Lowell Rd Apt 3123
Location 19/19Tucson, AZ 85712-1080 · Phone (520) 623-0344
No registry entries match your active lookup criteria.
