Healthcare Provider Details

I. General information

NPI: 1679910202
Provider Name (Legal Business Name): NAZCARE, INC - PRIDE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 W ARIZONA AVE SUITE 4
PARKER AZ
85344-5766
US

IV. Provider business mailing address

599 WHITE SPAR RD
PRESCOTT AZ
86303-4627
US

V. Phone/Fax

Practice location:
  • Phone: 928-442-9205
  • Fax:
Mailing address:
  • Phone: 928-442-9205
  • Fax: 602-535-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROBERTA LYNNE HOWARD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 928-442-9205