Healthcare Provider Details

I. General information

NPI: 1477151546
Provider Name (Legal Business Name): COMMUNITY 43
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 N 16TH ST
PHOENIX AZ
85016-5338
US

IV. Provider business mailing address

4343 N 16TH ST
PHOENIX AZ
85016-5338
US

V. Phone/Fax

Practice location:
  • Phone: 602-274-4343
  • Fax:
Mailing address:
  • Phone: 602-274-4343
  • Fax: 602-491-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARY JANE WATMAN
Title or Position: CEO
Credential:
Phone: 480-200-5179