Organization
AUDACIOUS LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA HILDRETH (OWNER)
(702) 683-5187
Entity
Organization
Contact information
Practice address
1922 W LAS PALMARITAS DR APT J110, PHOENIX, AZ 85021-5041
(702) 683-5187
Mailing address
1922 W LAS PALMARITAS DR APT J110, PHOENIX, AZ 85021-5041
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
09/03/2020
Last updated
09/20/2022
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