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12413 W Monroe St Avondale AZ 85323-8002 | |
| (623) 600-8283 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 12413 W Monroe St, Avondale, Arizona |
| Authorized Official Name and Position | Deogratias Baransaka (ADMINISTRATOR) |
| Authorized Official Contact | 6237608378 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12413 W Monroe St Avondale AZ 85323-8002 Ph: (623) 600-8384 | 12413 W Monroe St Avondale AZ 85323-8002 Ph: (623) 600-8283 |
| NPI Number | 1659157147 |
|---|---|
| Provider Enumeration Date | 08/31/2023 |
| Last Update Date | 10/16/2024 |
| Certification Date | 10/16/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659157147 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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