Healthcare Provider Details

I. General information

NPI: 1508693151
Provider Name (Legal Business Name): SNS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2942 N 24TH ST STE 206
PHOENIX AZ
85016-7850
US

IV. Provider business mailing address

7800 N 55TH AVE STE 102
GLENDALE AZ
85301-1322
US

V. Phone/Fax

Practice location:
  • Phone: 424-414-3762
  • 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 Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ZAKEYIA EDWARDS
Title or Position: OWNER/OPERATOR
Credential:
Phone: 773-641-3434