Individual
JAMIE ROSHUN DAWSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13229 S 48TH ST APT 3051, PHOENIX, AZ 85044
(501) 952-1976
Mailing address
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC., PO BOX 86537, TUSCON, AZ 85754-6537
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
10125986
AZ
385HR2055X
Child Mental Illness Respite Care
10125986
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10125986
AZ DEPT OF HEALTH SERVICES
AZ
01
—
1023637345
THERAPEUTIC FOSTER CARE
AZ
Enumeration date
04/16/2020
Last updated
09/11/2020
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