Healthcare Provider Details

I. General information

NPI: 1558084558
Provider Name (Legal Business Name): ABLE ABILITIES, LCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4852 S 20TH PL
PHOENIX AZ
85040-2513
US

IV. Provider business mailing address

2320 E BASELINE RD STE 148-485
PHOENIX AZ
85042-6966
US

V. Phone/Fax

Practice location:
  • Phone: 602-283-4144
  • Fax:
Mailing address:
  • Phone: 480-679-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based 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
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CLIFFORD FOXWORTH
Title or Position: OWNER
Credential:
Phone: 480-679-8715