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Hc 61, Box D Edventures Program C/o Leupp Schools Inc Leupp AZ 86047 | |
(520) 907-6890 | |
(801) 944-2940 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | Hc 61, Box D, Leupp, Arizona |
Authorized Official Name and Position | Siamak Khadjenoury (CEO) |
Authorized Official Contact | 5209076890 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8848 Willow Hills Ct Sandy UT 84093-1889 Ph: (520) 907-6890 | Hc 61, Box D Edventures Program C/o Leupp Schools Inc Leupp AZ 86047 Ph: (520) 907-6890 |
NPI Number | 1316198302 |
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Provider Enumeration Date | 10/08/2008 |
Last Update Date | 10/08/2008 |
Identifier | Type | State | Issuer |
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1316198302 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |