Organization
AZ INTERACT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDUARDO SANTANA (SUPERVISOR)
(602) 487-8806
Entity
Organization
Contact information
Practice address
6055 WEST CARIBE LANE, GLENDALE, AZ 85306
(602) 487-8806
Mailing address
2325 W DESPERADO WAY, PHOENIX, AZ 85085-5777
(602) 487-8806
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
BH4514
AZ
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
BH4801
AZ
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
BH4802
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154781037
—
AZ
05
—
1518327493
—
AZ
05
—
1760885347
—
AZ
Enumeration date
08/12/2016
Last updated
08/12/2016
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