Healthcare Provider Details

I. General information

NPI: 1790384030
Provider Name (Legal Business Name): GREAT XPECTATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 W CHRISTY DR
PHOENIX AZ
85029-3958
US

IV. Provider business mailing address

14955 W BELL RD UNIT 9108
SURPRISE AZ
85374-8286
US

V. Phone/Fax

Practice location:
  • Phone: 480-406-2313
  • Fax:
Mailing address:
  • Phone: 480-406-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARON ORANGE
Title or Position: DIRECTOR
Credential:
Phone: 480-406-2313