Healthcare Provider Details

I. General information

NPI: 1790991446
Provider Name (Legal Business Name): MARC COMMUNITY RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 11/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 N COUNTRY CLUB DR BUILDING 3
MESA AZ
85201-4108
US

IV. Provider business mailing address

924 N COUNTRY CLUB DR
MESA AZ
85201-4108
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-3800
  • Fax: 480-834-7003
Mailing address:
  • Phone: 480-969-3800
  • Fax: 480-834-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier811837
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name: MICHAEL FRANCZAK
Title or Position: EXECUTIVE VICE PRESIDENT OF BHS
Credential: PH.D.
Phone: 480-969-3800