Healthcare Provider Details

I. General information

NPI: 1700593373
Provider Name (Legal Business Name): FOR ALL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W NORTHERN AVE
PHOENIX AZ
85021-5469
US

IV. Provider business mailing address

1717 W NORTHERN AVE
PHOENIX AZ
85021-5469
US

V. Phone/Fax

Practice location:
  • Phone: 602-628-3211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMMAR ALSOUBAII
Title or Position: OWNER
Credential:
Phone: 602-628-3211