Organization
FSL PROGRAMS
Active
Other names
ADHC - Glendale
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANNETTE INIGUEZ (EXEC ASSISTANT)
(602) 285-0505
Entity
Organization
Contact information
Practice address
6010 W NORTHERN AVE, #800, GLENDALE, AZ 85301-1254
(623) 931-0983
(623) 939-2815
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-029
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
572439
—
AZ
01
—
ADHC-029
ADHS LICENSE#
AZ
01
—
BH-847
ADHS BEHAVIORAL
AZ
Enumeration date
12/29/2006
Last updated
08/22/2020
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