1598942302 NPI number — HABILITATION AND INDEPENDANT LIVING

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 1598942302 NPI number — HABILITATION AND INDEPENDANT LIVING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HABILITATION AND INDEPENDANT LIVING
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:
ANODYME DEVELOPMENT
Provider Other Organization Name Type Code:
3
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:
1598942302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5255 W. PORT AU PRINCE LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-217-8277
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12291 W. CABRILLO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARIZONA CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-217-8277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WOODS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
RUSTY
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
623-217-8277

Provider Taxonomy Codes

  • Taxonomy code: 3104A0625X , 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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