Organization
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Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARAS L COLLUM (OWNER)
(702) 235-5650
Entity
Organization
Contact information
Practice address
12615 N CAVE CREEK RD, PHOENIX, AZ 85022-5832
(702) 235-5650
Mailing address
12615 N CAVE CREEK RD, PHOENIX, AZ 85022-5832
(702) 235-5650
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/19/2021
Last updated
03/19/2021
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