Organization
A BROAD JOURNEY INTERVENTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LATANYA KING MAED (CEO)
(602) 488-0135
Entity
Organization
Contact information
Practice address
619 W BEAUTIFUL LN, PHOENIX, AZ 85041-8050
(602) 488-0135
(602) 314-6073
Mailing address
6216 S 36TH ST, PHOENIX, AZ 85042-4904
(602) 488-0135
(602) 314-6073
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
—
—
Other
Enumeration date
06/10/2016
Last updated
06/10/2016
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