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Organization

NORTHWEST ORGANIZATION FOR VOLUNTARY ALTERNATIVES

Active
Other names
DBA: Maverick House
Organization subpart
No

Provider details

NPI number
Authorized official
MR. EDWARD WILLIAM PINNOW (ACTING DIRECTOR)
(623) 937-9203
Entity
Organization

Contact information

Practice address
5801 NORTH 51ST AVENUE SUITE 109, GLENDALE, AZ 85301
(623) 931-5810
(623) 931-1302
Mailing address
4425 WEST OLIVE AVENUE SUITE 200, GLENDALE, AZ 85302
(623) 937-9203
(623) 930-0358

Taxonomy

Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
BH 406
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
346058
AHCCCS
AZ
Enumeration date
10/02/2007
Last updated
04/07/2014
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