Organization
PROJECT180-PHOENIX, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSALYN YOUNG MAC, CADC, MS (ADMINISTRATOR)
(311) 261-7785
Entity
Organization
Contact information
Practice address
6736 W CARSON RD, LAVEEN, AZ 85339-7024
(602) 888-6779
Mailing address
1507 E 53RD ST UNIT 247, CHICAGO, IL 60615-4573
(312) 617-7857
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
BH5362
AZ
Other
Enumeration date
03/09/2018
Last updated
12/09/2019
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