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Organization

VALLEYLIFE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LINDA RABE (PROGRAM MANAGER)
(602) 371-0806
Entity
Organization

Contact information

Practice address
1142 W HATCHER RD, PHOENIX, AZ 85021-3045
(602) 371-0806
Mailing address
1142 W HATCHER RD, PHOENIX, AZ 85021-3045
(602) 371-0806

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
017774
AZ
251J00000X
Nursing Care Agency
017774
AZ
252Y00000X
Early Intervention Provider Agency
017774
AZ
253Z00000X
In Home Supportive Care Agency
Primary
017774
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
017774
AHCCCS
AZ
Enumeration date
07/21/2009
Last updated
09/10/2009
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