| NPI | 1033509070 |
|---|---|
| Other Name | FIFTH STREET INTEGRATED CLINIC |
| Entity Type | Organization |
| Authorized Contact | RODNEY COOK Chief Executive Officer 520-792-3293 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: AZ otc6987) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: AZ OTC6987) |
| 251B00000X Case Management (Licence: AZ otc6987) | |
| 251S00000X (Licence: AZ OTC6987) | |
| 261QC1500X Clinic/Center, Community Health (Licence: AZ otc6987) | |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2021-08-27 |