Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2016-10-24
- Last updated
- 2016-10-24
Specialties
Licenses
- License PA
- 007411
Location
- Practice location
- 5 SAN CARLOS AVE
- City
- SAN CARLOS AZ
- Postal code
- 85550
- Phone
- 928-475-4875
Organization contact
- Name
- JOSEPH SIMMONS
- Title
- Child Services Clinical Coordinator
- Phone
- 9284754875
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.