1457879363 NPI number — AGAINST ALL ODDS INTEGRATED COMMUNITY CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457879363 NPI number — AGAINST ALL ODDS INTEGRATED COMMUNITY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGAINST ALL ODDS INTEGRATED COMMUNITY CARE
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:
1457879363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3005 E SUPERIOR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN TAN VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85143-4580
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:
3707 E SOUTHERN AVE STE 1015
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-6201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-397-9737
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WESLEY
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
VELT
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
602-397-9737

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , 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)





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