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1225 E Broadway Rd Ste 240 Tempe AZ 85282-1526 | |
| (480) 929-5100 | |
| (480) 731-1066 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1225 E Broadway Rd Ste 240, Tempe, Arizona |
| Authorized Official Name and Position | Grace Dyson-porter (SITE ADMINISTRATOR) |
| Authorized Official Contact | 4809295100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1225 E. Broadway Rd Ste 240 Tempe AZ 85282 Ph: (480) 929-5100 | 1225 E Broadway Rd Ste 240 Tempe AZ 85282-1526 Ph: (480) 929-5100 |
| NPI Number | 1770743213 |
|---|---|
| Provider Enumeration Date | 06/09/2008 |
| Last Update Date | 06/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770743213 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | RN087838 (Arizona) | Primary |
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