Organization
NEW EXODOS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHIL MC ILVEEN (PROGRAM DIRECTOR)
(602) 368-8966
Entity
Organization
Contact information
Practice address
5320 N 16TH ST, 204, PHOENIX, AZ 85016-3220
(602) 368-8966
Mailing address
5320 N 16TH ST, 204, PHOENIX, AZ 85016-3220
(602) 368-8966
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/09/2013
Last updated
09/09/2013
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