Healthcare Provider Details

I. General information

NPI: 1922798677
Provider Name (Legal Business Name): PARENT INFORMATION DISTRIBUTION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 S 48TH ST STE I&J
TEMPE AZ
85282-1010
US

IV. Provider business mailing address

15887 W LINDEN ST
GOODYEAR AZ
85338-4158
US

V. Phone/Fax

Practice location:
  • Phone: 623-383-0375
  • Fax:
Mailing address:
  • Phone: 623-383-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRENDA HULL-BERRY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 623-383-0375