Healthcare Provider Details

I. General information

NPI: 1285870600
Provider Name (Legal Business Name): E.P.MONK DEVELOPEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6129 W INDIANOLA AVE
PHOENIX AZ
85033-4138
US

IV. Provider business mailing address

8020 N 12TH ST
PHOENIX AZ
85020-3802
US

V. Phone/Fax

Practice location:
  • Phone: 602-441-2691
  • Fax: 602-358-7269
Mailing address:
  • Phone: 602-441-2691
  • Fax: 602-358-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberBH3141
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License NumberBH3141
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH3141
License Number StateAZ

VIII. Authorized Official

Name: MS. ELIZABETH SINGLETON
Title or Position: ADMIN MANAGEMENT
Credential:
Phone: 602-441-2691