Provider Demographics
NPI:1366779076
Name:CENTRAL AZ SPECIAL SERVICES, INC
Entity type:Organization
Organization Name:CENTRAL AZ SPECIAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-253-9588
Mailing Address - Street 1:2050 E UNIVERSITY DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-6700
Mailing Address - Country:US
Mailing Address - Phone:602-253-9588
Mailing Address - Fax:602-258-0207
Practice Address - Street 1:2050 E UNIVERSITY DR
Practice Address - Street 2:SUITE 3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-6700
Practice Address - Country:US
Practice Address - Phone:602-253-9588
Practice Address - Fax:602-258-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ042416251E00000X, 253Z00000X, 385H00000X, 385HR2060X, 385HR2065X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child