| Project180-phoenix, Llc | |
|
6736 W Carson Rd Laveen AZ 85339-7024 | |
| (602) 888-6779 | |
| Not Available |
| Full Name | Project180-phoenix, Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 6736 W Carson Rd, Laveen, Arizona |
| Authorized Official Name and Position | Rosalyn Young (ADMINISTRATOR) |
| Authorized Official Contact | 3112617785 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Project180-phoenix, Llc 1507 E 53rd St Unit 247 Chicago IL 60615-4573 Ph: (312) 617-7857 | Project180-phoenix, Llc 6736 W Carson Rd Laveen AZ 85339-7024 Ph: (602) 888-6779 |
| NPI Number | 1336642958 |
|---|---|
| Provider Enumeration Date | 03/09/2018 |
| Last Update Date | 12/09/2019 |
| Certification Date | 12/09/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336642958 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | BH5362 (Arizona) | Primary |
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