Healthcare Provider Details

I. General information

NPI: 1346843901
Provider Name (Legal Business Name): NEXT LEVEL CRISIS CONNECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 N 15TH AVE STE 102
PHOENIX AZ
85015-3329
US

IV. Provider business mailing address

5040 N 15TH AVE STE 102
PHOENIX AZ
85015-3329
US

V. Phone/Fax

Practice location:
  • Phone: 619-244-0221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ANITRA STANSIL
Title or Position: OWNER
Credential:
Phone: 619-244-0221