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Organization
DIAMOND GIRL ROCK DYNASTY NONPROFIT MUSIC ORGANIZATION
Active
Organization
DIAMOND GIRL ROCK DYNASTY NONPROFIT MUSIC ORGANIZATION
Active
Other names
Diamond Dynasty
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONETTE PATRICE PEARSON (PROGRAM DIRECTOR)
(623) 268-7813
Entity
Organization
Contact information
Practice address
7552 W WELDON AVE, PHOENIX, AZ 85033-3721
(480) 280-3707
Mailing address
7552 W WELDON AVE, PHOENIX, AZ 85033-3721
(480) 280-3707
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QE0002X
Emergency Care Clinic/Center
Primary
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000789345
—
AZ
01
—
00000789346
BLUECROSS BLUESHIELD
AZ
01
—
00000789347
AETNA
AZ
Enumeration date
01/25/2022
Last updated
01/25/2022
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