Organization
FSL PROGRAMS
Active
Other names
ADHC - Tolleson
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANNETTE INIGUEZ (EXEC ASST)
(602) 285-0505
Entity
Organization
Contact information
Practice address
9555 W VAN BUREN ST, TOLLESON, AZ 85353-2816
(623) 932-1104
(623) 923-1132
Mailing address
1201 E THOMAS RD, PHOENIX, AZ 85014-5734
(602) 285-1800
(602) 285-1838
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
ADHC-1919
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5683
ADHS LICENSE
AZ
05
—
572372
—
AZ
Enumeration date
12/28/2006
Last updated
07/07/2008
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