Healthcare Provider Details

I. General information

NPI: 1982070272
Provider Name (Legal Business Name): UPWARD FOR CHILDREN AND FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6306 N 7TH ST
PHOENIX AZ
85014-1549
US

IV. Provider business mailing address

6306 N 7TH ST
PHOENIX AZ
85014-1549
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-5801
  • Fax: 602-279-0033
Mailing address:
  • Phone: 602-279-5801
  • Fax: 602-279-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number189944
License Number StateAZ

VIII. Authorized Official

Name: MRS. ELANA L MASTOV
Title or Position: SCHOOL NURSE
Credential: RN
Phone: 602-279-5801