Organization
FULFILLMENT IN TRAINING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN BAINES (CHIEF EXECUTIVE OFFICER)
(480) 326-7762
Entity
Organization
Contact information
Practice address
7117 S 7TH LN, PHOENIX, AZ 85041-6766
(480) 326-7762
Mailing address
7117 S 7TH LN, PHOENIX, AZ 85041-6766
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/26/2023
Last updated
09/26/2023
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