Individual
JHEREMY PETE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1718 N 77TH GLN, PHOENIX, AZ 85035-5053
(623) 337-0256
Mailing address
1718 N 77TH GLN, PHOENIX, AZ 85035-5053
(623) 337-0256
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/16/2021
Last updated
10/01/2021
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