Organization
PEOPLE OF COLOR NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANUEL TOMAS LEON (CHIEF EXECUTIVE OFFICER)
(602) 253-3084
Entity
Organization
Contact information
Practice address
77 E.THOMAS ROAD, SUITE 230, PHOENIX, AZ 85012-3100
(602) 253-3084
(602) 253-3732
Mailing address
77 EAST THOMAS ROAD, SUITE 230, PHOENIX, AZ 85012-3100
(602) 253-3084
(602) 253-3732
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
BH-2585
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
703547
AHCCCS PROVIDER NUMBER
AZ
01
—
BH2828
ARIZONA BEHAVIORAL HEALTH
AZ
Enumeration date
11/08/2005
Last updated
10/04/2011
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