Organization
AGRICOLA WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DWAYNE BARROW (OWNER)
(404) 697-7506
Entity
Organization
Contact information
Practice address
2150 S COUNTRY CLUB DR STE 29, MESA, AZ 85210-6860
(404) 697-7506
Mailing address
2150 S COUNTRY CLUB DR STE 29, MESA, AZ 85210-6860
(404) 697-7506
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC11904
ADHS
AZ
Enumeration date
09/01/2022
Last updated
09/01/2022
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