Organization
SUPERIOR OUTPATIENT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ABDISAAK MOHAMUD (OWNER)
(612) 306-0639
Entity
Organization
Contact information
Practice address
3201 W PEORIA AVE STE B408, PHOENIX, AZ 85029-4610
(612) 306-0639
Mailing address
5545 W WALATOWA ST, LAVEEN, AZ 85339-5498
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC12666
AZDHS
AZ
Enumeration date
06/20/2023
Last updated
06/20/2023
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