Individual
ANGELA CARLISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14615 S AVENIDA CUCANA, SAHUARITA, AZ 85629-8620
(503) 919-0899
Mailing address
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC, 994 S HARRISON RD, TUCSON, AZ 85748-6608
(520) 721-1887
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
8770443
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8770443
THERAPEUTIC FOSTER CARE
AZ
Enumeration date
12/19/2017
Last updated
10/24/2019
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