Healthcare Provider Details

I. General information

NPI: 1194314583
Provider Name (Legal Business Name): ADAS-ADAMA DEVELOPMENTAL ASSISTANCE & SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9304 W OREGON AVE
GLENDALE AZ
85305-3343
US

IV. Provider business mailing address

9304 W OREGON AVE
GLENDALE AZ
85305-3343
US

V. Phone/Fax

Practice location:
  • Phone: 602-829-0907
  • Fax:
Mailing address:
  • Phone: 602-900-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ADAMA KAMARA
Title or Position: OWNER AND CEO
Credential: MPA
Phone: 602-829-0907