Individual
RANDY BLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14047 W MONTE VISTA RD, GOODYEAR, AZ 85395
(480) 334-2092
Mailing address
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC., PO BOX 86537, TUCSON, AZ 85754-6537
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
10126301
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10126301
AZ DEPT OF HEALTH SERVICES
AZ
01
—
1700423902
THERAPEUTIC FOSTER CARE
AZ
Enumeration date
12/06/2019
Last updated
06/29/2021
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