# MARY'S MISSION & DEVELOPMENTAL CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083725832
- **Authorized official:** MR. WILLIAM LACEY JR. MBA (CEO/ADMINISTRATOR)
- **Authorized official phone:** (520) 417-2115

## Contact information

- **Practice address:** 345 TAYLOR DR, SIERRA VISTA, AZ 85635-3801
- **Practice address phone:** (520) 417-2115
- **Practice address fax:** (520) 417-2114
- **Mailing address:** 345 TAYLOR DR, SIERRA VISTA, AZ 85635-3801
- **Mailing address phone:** (520) 417-2115
- **Mailing address fax:** (520) 417-2114

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | BH-1422 | AZ | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 08/22/2020