Healthcare Provider Details

I. General information

NPI: 1790080042
Provider Name (Legal Business Name): TRANSITIONS FOR THE DEVELOPMENTALLY DISABLED, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17018 S 26TH ST
PHOENIX AZ
85048-8226
US

IV. Provider business mailing address

17018 S 26TH ST
PHOENIX AZ
85048-8226
US

V. Phone/Fax

Practice location:
  • Phone: 480-940-7915
  • Fax:
Mailing address:
  • Phone: 480-940-7915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberE2094675
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberE2094675
License Number StateAZ

VIII. Authorized Official

Name: DENNIS KARP
Title or Position: VICE-PRESIDENT, CFO
Credential:
Phone: 480-940-7915