Individual
ROUT THAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4911 W MALDONADO RD, LAVEEN, AZ 85339-8217
(480) 275-1056
Mailing address
4911 W MALDONADO RD, LAVEEN, AZ 85339-8217
(480) 275-1056
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
SLH10481
AZ
251S00000X
Community/Behavioral Health Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
3031899
AZ
Other
Enumeration date
02/02/2023
Last updated
02/02/2023
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