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General NPI Number Information
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NPI Number | 1093855082
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Entity Type | Organization
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Legal Business Name | NOAHS ARK FAMILY CLINIC CORP
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 6707 N 19TH AVE STE 105
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City | PHOENIX
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State | AZ
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Zip | 85015-1105
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Country | US
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Telephone | 480-247-7691
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Fax | 480-919-7040
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Provider Business Mailing Address
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Address Line | 7800 N 55TH AVE STE 106&107
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City | GLENDALE
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State | AZ
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Zip | 85301-1321
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Country | US
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Telephone | 623-931-5001
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Fax | 623-931-5120
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DANNY NGUYEN
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Credential | PRESIDENT/CEO
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Telephone | 480-332-8832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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Taxonomy #3
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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Taxonomy #6
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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