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Organization

ACTIVE FAMILY SOLUTIONS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RICHARD G GLENNRELLER OTR (OWNER)
(602) 769-2532
Entity
Organization

Contact information

Practice address
13327 N 152ND AVE, SURPRISE, AZ 85379-9119
(602) 769-2532
Mailing address
13327 N 152ND AVE, SURPRISE, AZ 85379-9119
(602) 769-2532

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
3836
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
184791
ARIZONA DEPARTMENT OF ECONOMIC SECURITIES
AZ
Enumeration date
08/06/2009
Last updated
08/06/2009
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