Organization
DOC'S PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSHUA C BRIMHALL (DIRECTOR)
(480) 205-5545
Entity
Organization
Contact information
Practice address
1722 E TAMAR RD, PHOENIX, AZ 85086-8454
(623) 233-4488
(623) 240-2302
Mailing address
1722 E TAMAR RD, PHOENIX, AZ 85086-8454
(623) 233-4488
(623) 240-2302
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081226
AHCCCS
AZ
01
—
AL11222H
DEPT. HEALTH SERVICES LICENSE
AZ
Enumeration date
11/27/2020
Last updated
11/27/2020
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