MEDICARE: CINDY HICKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)	BH2617	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	BH2617	OTHER	AZ	BEHAVIORAL HEALTH LICENSE

General Provider Information

NPI Number	:	1720130404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CINDY HICKS

Provider Business Mailing Address
First Line	:	4602 W MONTE CRISTO AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-2724
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4602 W MONTE CRISTO AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-2724
Country	:	US
Telephone Number	:	602-547-9682
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CINDY HICKS
Credential	:
Telephone Number	:	602-547-9682

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	06/23/2008

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Directions to “CINDY HICKS ” Practice Location

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