| Mikid Mentally Ill Kids In Distress | |
|
901 E Cottonwood Ln Ste Ab Casa Grande AZ 85122-2221 | |
| (520) 509-6669 | |
| Not Available |
| Full Name | Mikid Mentally Ill Kids In Distress |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 901 E Cottonwood Ln Ste Ab, Casa Grande, Arizona |
| Authorized Official Name and Position | Jeff Kazmierczak (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6022531240 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mikid Mentally Ill Kids In Distress 7816 N 19th Ave Phoenix AZ 85021-7036 Ph: (602) 253-1240 | Mikid Mentally Ill Kids In Distress 901 E Cottonwood Ln Ste Ab Casa Grande AZ 85122-2221 Ph: (520) 509-6669 |
| NPI Number | 1407257595 |
|---|---|
| Provider Enumeration Date | 09/09/2014 |
| Last Update Date | 08/14/2024 |
| Certification Date | 08/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407257595 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | OTC8547 (Arizona) | Primary |
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