Organization
MARY'S MISSION & DEVELOPMENTAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM LACEY JR. MBA (CEO/ADMINISTRATOR)
(520) 417-2115
Entity
Organization
Contact information
Practice address
736 N COUNTRY CLUB DR, MESA, AZ 85201-4936
(520) 417-2115
(520) 417-2114
Mailing address
345 TAYLOR DR, SIERRA VISTA, AZ 85635-3801
(520) 417-2115
(520) 417-2114
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH-3732
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
787848
AHCCCS
AZ
Enumeration date
11/29/2010
Last updated
11/29/2010
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