Organization
RODTREE WEST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODNEY PEARSON (OWNER/)
(602) 690-1643
Entity
Organization
Contact information
Practice address
12379 W CAMPBELL AVE, AVONDALE, AZ 85392-4298
(602) 690-1643
Mailing address
12379 W CAMPBELL AVE, AVONDALE, AZ 85392-4298
(602) 690-1643
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
—
AZ
252Y00000X
Early Intervention Provider Agency
—
AZ
253Z00000X
In Home Supportive Care Agency
Primary
—
AZ
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
303384
—
AZ
Enumeration date
11/27/2009
Last updated
11/27/2009
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