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Organization
MARY'S MISSION & DEVELOPMENTAL CENTER, INC.
Active
Organization
MARY'S MISSION & DEVELOPMENTAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM LACEY M.B.A. (CEO/ADMINISTRATOR)
(520) 417-2115
Entity
Organization
Contact information
Practice address
8360 S HIGHWAY 92, HEREFORD, AZ 85615-9087
(520) 378-5175
(520) 459-3642
Mailing address
345 TAYLOR DR, SIERRA VISTA, AZ 85635-3801
(520) 417-2115
(520) 417-2114
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH-2206
AZ
Other
Enumeration date
08/31/2006
Last updated
08/22/2020
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