Organization
101 WALL SUPPORT SERVICES LLC
Active
Organization
101 WALL SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN CHRISTAIN TAYLOR (CHIEF EXECUTIVE OFFICER)
(480) 285-9426
Entity
Organization
Contact information
Practice address
919 N STAPLEY DR, SUITE M, MESA, AZ 85203-5639
(480) 285-9426
(480) 907-1358
Mailing address
919 N STAPLEY DR, SUITE M, MESA, AZ 85203-5639
(480) 285-9426
(480) 907-1358
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH-4204
AZ
Other
Enumeration date
07/23/2013
Last updated
07/23/2013
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