Individual
IDRIS ROBERSON
Active
Individual
IDRIS ROBERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
221509-14979
AZ
Other
Enumeration date
09/15/2023
Last updated
09/15/2023
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