| NPI | 1548016157 |
|---|---|
| Former Legal Business Name | 5150 N 15TH AVE LLC |
| Entity Type | Organization |
| Authorized Contact | VALENA JORDAN Administrator 602-782-0216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2024-04-24 |
| Last Update Date | 2024-04-24 |