Individual
HAROLD KILGORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3734 E LONGHORN ST, QUEEN CREEK, AZ 85140-4303
(602) 321-4154
Mailing address
3734 E LONGHORN ST, QUEEN CREEK, AZ 85140-4303
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
7470789
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7470789
AZ DEPT OF HEALTH SERVICES
AZ
Enumeration date
06/18/2019
Last updated
06/18/2019
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