Healthcare Provider Details

I. General information

NPI: 1467952143
Provider Name (Legal Business Name): AVOCA HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2237 N AVOCA
MESA AZ
85207-2028
US

IV. Provider business mailing address

2414 W OLD PAINT TRL
PHOENIX AZ
85086-6608
US

V. Phone/Fax

Practice location:
  • Phone: 480-399-8735
  • Fax:
Mailing address:
  • Phone: 480-399-8735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL10378H
License Number StateAZ

VIII. Authorized Official

Name: MR. LANDIS MAEZ
Title or Position: DIRECTOR
Credential:
Phone: 480-399-8735