Organization
NORTHWEST ORGANIZATION FOR VOLUNTARY ALTERNATIVES
Active
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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