Organization
SUCCESS RESIDENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAAMA ABUKARI MD (ADMINISTRATOR)
(917) 891-4320
Entity
Organization
Contact information
Practice address
5120 E WALLACE WAY, SAN TAN VALLEY, AZ 85143-5161
(917) 891-4320
Mailing address
5120 E WALLACE WAY, SAN TAN VALLEY, AZ 85143-5161
(917) 891-4320
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
02/18/2021
Last updated
02/18/2021
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