Healthcare Provider Details

I. General information

NPI: 1659882694
Provider Name (Legal Business Name): DEVOTED GUARDIANS DDD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 W RUBY DR STE 107
TEMPE AZ
85284-1060
US

IV. Provider business mailing address

1705 W RUBY DR STE 107
TEMPE AZ
85284-1060
US

V. Phone/Fax

Practice location:
  • Phone: 602-743-8414
  • Fax: 480-656-6782
Mailing address:
  • Phone: 602-743-8414
  • Fax: 480-656-6782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. AARON SINYKIN
Title or Position: CEO
Credential:
Phone: 602-743-8414