| Mary's Mission & Developmental Center, Inc. | |
|
736 N Country Club Dr Mesa AZ 85201-4936 | |
| (520) 417-2115 | |
| (520) 417-2114 |
| Full Name | Mary's Mission & Developmental Center, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 736 N Country Club Dr, Mesa, Arizona |
| Authorized Official Name and Position | William Lacey (CEO/ADMINISTRATOR) |
| Authorized Official Contact | 5204172115 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary's Mission & Developmental Center, Inc. 345 Taylor Dr Sierra Vista AZ 85635-3801 Ph: (520) 417-2115 | Mary's Mission & Developmental Center, Inc. 736 N Country Club Dr Mesa AZ 85201-4936 Ph: (520) 417-2115 |
| NPI Number | 1912209859 |
|---|---|
| Provider Enumeration Date | 11/29/2010 |
| Last Update Date | 11/29/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912209859 | NPI | - | NPPES |
| 787848 | Other | AZ | AHCCCS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | BH-3732 (Arizona) | Primary |
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