Organization
AVID SUPPORT RESOURCES LLC
Active
Other names
AVID Support Resources LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TANISHA LAWRENCE (OWNER)
(623) 210-5169
Entity
Organization
Contact information
Practice address
8705 W MORTEN AVE, GLENDALE, AZ 85305-3944
(623) 210-5169
Mailing address
8705 W MORTEN AVE, GLENDALE, AZ 85305-3944
(623) 210-5169
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/22/2022
Last updated
04/22/2022
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