| La Frontera Empact-spc | |
|
21476 N John Wayne Pkwy Suite C101 Maricopa AZ 85139-8983 | |
| (520) 316-6068 | |
| Not Available |
| Full Name | La Frontera Empact-spc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 21476 N John Wayne Pkwy, Maricopa, Arizona |
| Authorized Official Name and Position | Laura Larson-huffaker (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4807841514 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| La Frontera Empact-spc 618 S Madison Dr Tempe AZ 85281-7248 Ph: (480) 784-1514 | La Frontera Empact-spc 21476 N John Wayne Pkwy Suite C101 Maricopa AZ 85139-8983 Ph: (520) 316-6068 |
| NPI Number | 1073911293 |
|---|---|
| Provider Enumeration Date | 12/22/2014 |
| Last Update Date | 03/24/2022 |
| Certification Date | 03/24/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073911293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LPC14160 (Arizona) | Primary |
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