Organization
NIRVANA SQUARED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRAVIS PLUMMER (CEO)
(301) 366-5675
Entity
Organization
Contact information
Practice address
1027 E SELDON LN, PHOENIX, AZ 85020-3259
(301) 366-5675
Mailing address
7426 E STETSON DR UNIT 3017E, SCOTTSDALE, AZ 85251-3877
(301) 366-5675
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/26/2021
Last updated
05/26/2021
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