Provider Demographics
NPI:1871315838
Name:VICTIM WITNESS SERVICES FOR COCONINO COUNTY
Entity type:Organization
Organization Name:VICTIM WITNESS SERVICES FOR COCONINO COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-856-7676
Mailing Address - Street 1:201 E BIRCH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5215
Mailing Address - Country:US
Mailing Address - Phone:928-856-7676
Mailing Address - Fax:
Practice Address - Street 1:201 E BIRCH AVE STE 4
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5215
Practice Address - Country:US
Practice Address - Phone:928-856-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty