Individual
MINELL HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1320 E PALO VERDE DR., CASA GRANDE, AZ 85122
(480) 845-9222
Mailing address
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC, PO BOX 86537, TUCSON, AZ 85754-6537
(480) 845-9222
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
9233373
AZ
385H00000X
Respite Care
BH5085
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH5085
AZ DEPT OF HEALTH SERVICES
AZ
Enumeration date
01/24/2017
Last updated
09/15/2020
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