1023432465 NPI number — ARIZONA CHILDRENS THERAPY CENTER LLC

Table of content: (NPI 1023432465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023432465 NPI number — ARIZONA CHILDRENS THERAPY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA CHILDRENS THERAPY CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023432465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8607 N 59TH AVE
Provider Second Line Business Mailing Address:
SUITE C-6
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85302-5433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7545 W REDBIRD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85383-6253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-510-1599
Provider Business Practice Location Address Fax Number:
623-258-4136
Provider Enumeration Date:
02/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
ROY
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
480-510-1599

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP5146 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 868036 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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