Healthcare Provider Details

I. General information

NPI: 1871459115
Provider Name (Legal Business Name): THE FORT GREENE PROJECT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3836 S 54TH GLN
PHOENIX AZ
85043-4762
US

IV. Provider business mailing address

3836 S 54TH GLN
PHOENIX AZ
85043-4762
US

V. Phone/Fax

Practice location:
  • Phone: 602-430-8861
  • Fax:
Mailing address:
  • Phone: 602-430-8861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMEKE LAMAR MITCHELL-WALKER
Title or Position: CEO
Credential:
Phone: 602-430-8861