Organization
LIFE CHANGE FAMILY SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CLAUDETTE WALKER BS (PRESIDENT)
(520) 374-0072
Entity
Organization
Contact information
Practice address
20018 N TOLEDO AVE, MARICOPA, AZ 85138-5359
(520) 374-0072
Mailing address
20018 N TOLEDO AVE, MARICOPA, AZ 85138-5359
(520) 374-0072
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
BH 5008
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH 5008
ARIZONA DEPARTMENT OF HEALTH LICENSE
AZ
Enumeration date
10/13/2016
Last updated
10/13/2016
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