Organization
MWCGP OUTPATIENT CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOSIA KING (OWNER)
(262) 748-2596
Entity
Organization
Contact information
Practice address
8650 N 35TH AVE STE 105, PHOENIX, AZ 85051-3835
(262) 748-2596
Mailing address
8828 S SANTA ELIZABETH DR, GOODYEAR, AZ 85338-7013
(262) 748-2596
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
—
—
174200000X
Meals Provider
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
04/16/2025
Last updated
04/29/2025
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