Healthcare Provider Details

I. General information

NPI: 1841643632
Provider Name (Legal Business Name): THE PHOENIX CHILDREN'S CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 E CAMELBACK RD STE 170
PHOENIX AZ
85016-3911
US

IV. Provider business mailing address

1661 E CAMELBACK RD STE 170
PHOENIX AZ
85016-3911
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-7767
  • Fax: 602-274-1552
Mailing address:
  • Phone: 602-279-7767
  • Fax: 602-274-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberAP8802
License Number StateAZ

VIII. Authorized Official

Name: MRS. JENNIFER LYNN WILLIAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-279-7767