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NPI Code Detail

MEDICARE: MAKING A DIFFERENCE

MEDICARE: MAKING A DIFFERENCE
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
1251S00000XCommunity/Behavioral Health AgencyBH2728AZ

General Provider Information

NPI Number : 1932323870
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAKING A DIFFERENCE
Provider Business Mailing Address
First Line : 6437 S 21ST PL
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-4652
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6437 S 21ST PL
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-4652
Country : US
Telephone Number : 602-276-6557
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. ROBERT WHEATON JR.
Credential :
Telephone Number : 602-505-1468
Provider Enumeration Date : 04/12/2007
Last Update Date : 06/26/2008

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Directions to “MAKING A DIFFERENCE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.