Individual
MR. JOHN CHARLES WAITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
—
—
385HR2055X
Child Mental Illness Respite Care
2838615
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
613805
—
AZ
Enumeration date
05/06/2011
Last updated
08/13/2021
Update your record
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