Organization
MIKID, MENTALLY ILL KIDS IN DISTRESS
Active
Organization
MIKID, MENTALLY ILL KIDS IN DISTRESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF KAZMIERCZAK RN,MSN,MBA (EXECUTIVE DIRECTOR)
(602) 253-1240
Entity
Organization
Contact information
Practice address
755 E WILLETTA ST, STE. 128, PHOENIX, AZ 85006-2723
(602) 253-1240
(602) 253-1250
Mailing address
755 E WILLETTA ST, STE. 128, PHOENIX, AZ 85006-2723
(602) 253-1240
(602) 253-1250
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
CSA05CP0172
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
895394
—
AZ
Enumeration date
07/31/2006
Last updated
08/14/2024
Update your record
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