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General NPI Number Information
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NPI Number | 1174236749
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Entity Type | Organization
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Legal Business Name | CENTER OF PEACE HEALTH SERVICES LLC
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Dates
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Enumeration Date | 12/28/2022
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 4480 W PEORIA AVE
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City | GLENDALE
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State | AZ
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Zip | 85302-2038
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Country | US
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Telephone | 702-743-4108
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Fax |
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Provider Business Mailing Address
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Address Line | 4480 W PEORIA AVE STE 2014480
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City | GLENDALE
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State | AZ
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Zip | 85302-2038
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Country | US
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Telephone | 602-400-0231
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | CLARISSA BROOKE DEWESE
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Credential |
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Telephone | 602-400-0231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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License Number State |
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