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Organization

POPS PROVISIONAL PLACE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MARCIA DIANNE CRAYTON LPN (ADMINISTRATOR)
(623) 693-3112
Entity
Organization

Contact information

Practice address
29741 W AMELIA AVE, BUCKEYE, AZ 85396-7169
(623) 693-3112
(623) 434-3882
Mailing address
29741 W AMELIA AVE, BUCKEYE, AZ 85396-7169
(623) 693-3112
(623) 434-3882

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
044613
AZ

Other

Enumeration date
09/14/2017
Last updated
07/21/2022
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