Organization
ARIZONA ALTERNATIVE SUPPORT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. IRENE N MULONDO RN, BSN (ADMINISTRATOR)
(774) 253-7365
Entity
Organization
Contact information
Practice address
36379 W EL GRECO ST, MARICOPA, AZ 85138-5323
(774) 253-7365
Mailing address
621 S WAYNE DR, CHANDLER, AZ 85225-2817
(774) 253-7365
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/09/2020
Last updated
07/09/2020
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