Organization
CORE VINE FAMILY SRV LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAWANDA MARIE BROOKS (OWNER)
(314) 473-0148
Entity
Organization
Contact information
Practice address
701 E WESTERN AVE, AVONDALE, AZ 85323-2425
(602) 487-8331
Mailing address
701 E WESTERN AVE, AVONDALE, AZ 85323-2425
(602) 487-8331
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/25/2023
Last updated
01/25/2023
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