Healthcare Provider Details

I. General information

NPI: 1518388289
Provider Name (Legal Business Name): BEFORE & AFTER HOME 4 BOYS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40408 W ART PL
MARICOPA AZ
85138-5149
US

IV. Provider business mailing address

41402 W HOPPER DR
MARICOPA AZ
85138-7278
US

V. Phone/Fax

Practice location:
  • Phone: 520-350-2198
  • Fax: 520-423-3915
Mailing address:
  • Phone: 520-350-2198
  • Fax: 520-423-3915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH4368
License Number StateAZ

VIII. Authorized Official

Name: DOLLIE BRAZIER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 414-218-3901