Healthcare Provider Details

I. General information

NPI: 1457879363
Provider Name (Legal Business Name): AGAINST ALL ODDS INTEGRATED COMMUNITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 E SOUTHERN AVE STE 1015
MESA AZ
85206-6201
US

IV. Provider business mailing address

3005 E SUPERIOR RD
SAN TAN VALLEY AZ
85143-4580
US

V. Phone/Fax

Practice location:
  • Phone: 602-397-9737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. RANDY VELT WESLEY JR.
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 602-397-9737