| Integrated Legacy Support Services, Llc | |
|
15526 W Rio Vista Ln Goodyear AZ 85338-9441 | |
| (480) 516-6081 | |
| Not Available |
| Full Name | Integrated Legacy Support Services, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 15526 W Rio Vista Ln, Goodyear, Arizona |
| Authorized Official Name and Position | Nashid Mateen (OWNER) |
| Authorized Official Contact | 4805166081 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Legacy Support Services, Llc Po Box 67472 Phoenix AZ 85082-7472 Ph: () - | Integrated Legacy Support Services, Llc 15526 W Rio Vista Ln Goodyear AZ 85338-9441 Ph: (480) 516-6081 |
| NPI Number | 1205680386 |
|---|---|
| Provider Enumeration Date | 04/15/2024 |
| Last Update Date | 04/15/2024 |
| Certification Date | 04/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205680386 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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