Organization
DIAMOND GIRL ROCK DYNASTY NONPROFIT MUSIC ORGANIZATION
Active
Other names
Diamond Dynasty
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONETTE PATRICE PEARSON (PROGRAM DIRECTOR)
(623) 268-7813
Entity
Organization
Contact information
Practice address
7552 W WELDON AVE, PHOENIX, AZ 85033-3721
(480) 280-3707
Mailing address
7552 W WELDON AVE, PHOENIX, AZ 85033-3721
(480) 280-3707
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QE0002X
Emergency Care Clinic/Center
Primary
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000789345
—
AZ
01
—
00000789346
BLUECROSS BLUESHIELD
AZ
01
—
00000789347
AETNA
AZ
Enumeration date
01/25/2022
Last updated
01/25/2022
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