Organization
DEVELOPMENTAL BH CONSULT
Active
Parent organization
PARC PLACE
Organization subpart
Yes
Provider details
NPI number
Legal business name
PARC PLACE
Authorized official
MICHAEL PUTOFF (CEO)
(480) 917-9301
Entity
Organization
Contact information
Practice address
2190 N GRACE BLVD, CHANDLER, AZ 85225-3416
(480) 917-9301
Mailing address
2190 N GRACE BLVD, CHANDLER, AZ 85225-3416
(480) 917-9301
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
357625
—
AZ
Enumeration date
04/09/2008
Last updated
04/09/2008
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