| Core Vine Family Srv Llc | |
|
701 E Western Ave Avondale AZ 85323-2425 | |
| (602) 487-8331 | |
| Not Available |
| Full Name | Core Vine Family Srv Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 701 E Western Ave, Avondale, Arizona |
| Authorized Official Name and Position | Lawanda Marie Brooks (OWNER) |
| Authorized Official Contact | 3144730148 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Core Vine Family Srv Llc 701 E Western Ave Avondale AZ 85323-2425 Ph: (602) 487-8331 | Core Vine Family Srv Llc 701 E Western Ave Avondale AZ 85323-2425 Ph: (602) 487-8331 |
| NPI Number | 1043926835 |
|---|---|
| Provider Enumeration Date | 01/25/2023 |
| Last Update Date | 01/25/2023 |
| Certification Date | 01/25/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043926835 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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