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Arizona ALTCS Office (AHCCCS/ALTCS) - Phoenix fax number
(602) 253-6385
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Arizona Department of Economic Security (ALTCS/AHCCCS)
Used for: ALTCS application processing and related correspondence; submission of ALTCS DE-101/DE-202 combo form; communication with the Phoenix ALTCS Office.
Fax destination details
- Department
- Arizona Department of Economic Security (ALTCS/AHCCCS)
- Purpose
- ALTCS application processing and related correspondence; submission of ALTCS DE-101/DE-202 combo form; communication with the Phoenix ALTCS Office.
- Form
- DE-101/DE-202 Combo form — Request for Application for Arizona Long Term Care System (ALTCS) DE-101/DE-202 Combo form
- Address
- Arizona ALTCS Phoenix Office, 150 N. 18th Ave, 2nd Floor, Phoenix, AZ 85007
- Voice phone
- 602-417-6600
- Website
- Visit organization website
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Submit the ALTCS DE-101/DE-202 combo form to AHCCCS via Health-e-Arizona Plus, or return by fax (888-507-3313), mail to AHCCCS ALTCS, P.O. Box 6050, MD 15023 ALTCS, Phoenix, AZ 85002-5520; or use the AHCCCS online submission.
Official form instructions are published as a downloadable file on the organization's website.
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