| 101 Wall Support Services Llc | |
|
919 N Stapley Dr Suite M Mesa AZ 85203-5639 | |
| (480) 285-9426 | |
| (480) 907-1358 |
| Full Name | 101 Wall Support Services Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 919 N Stapley Dr, Mesa, Arizona |
| Authorized Official Name and Position | Jonathan Christain Taylor (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4802859426 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 101 Wall Support Services Llc 919 N Stapley Dr Suite M Mesa AZ 85203-5639 Ph: (480) 285-9426 | 101 Wall Support Services Llc 919 N Stapley Dr Suite M Mesa AZ 85203-5639 Ph: (480) 285-9426 |
| NPI Number | 1568804342 |
|---|---|
| Provider Enumeration Date | 07/23/2013 |
| Last Update Date | 07/23/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568804342 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | BH-4204 (Arizona) | Primary |
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