Organization
COMMUNITY NETWORK AND FELLOW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KISHA BERNICE SPELLMAN (FACULTY ADMINISTRATOR)
(623) 533-1689
Entity
Organization
Contact information
Practice address
14019 N 149TH DR, SURPRISE, AZ 85379-6012
(623) 533-1689
(623) 547-6210
Mailing address
14019 N 149TH DR, SURPRISE, AZ 85379-6012
(623) 533-1689
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH2872
AZ
Other
Enumeration date
12/05/2007
Last updated
12/05/2007
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