Organization
AZ FAMILIES CO-OP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. REX ROGER MATTHEWS (PARTNER)
(855) 755-2932
Entity
Organization
Contact information
Practice address
4391 EAST MARSHALL CT, GILBERT, AZ 85297
(855) 755-2932
(855) 755-2932
Mailing address
5425 E BROADWAY BLVD # 286, TUCSON, AZ 85711-3704
(855) 755-2932
(855) 755-2932
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
429547
AHCCCS NUMBER
AZ
01
—
Q07201813808
DIVISION OF DEVELOPMENTAL DISABILITIES DDD
AZ
Enumeration date
03/18/2022
Last updated
03/18/2022
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