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General NPI Number Information
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NPI Number | 1275208746
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Entity Type | Organization
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Legal Business Name | THE IGNITE CARE GROUP, PLLC
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 12175 W MCDOWELL RD APT 1218
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City | AVONDALE
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State | AZ
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Zip | 85392-5303
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Country | US
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Telephone | 832-866-5726
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Fax |
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Provider Business Mailing Address
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Address Line | 875 S ESTRELLA PKWY UNIT 7823
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City | GOODYEAR
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State | AZ
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Zip | 85338-8614
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Country | US
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Telephone | 832-866-5726
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | MISS KETURA C JAMES
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Credential | NP
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Telephone | 832-866-5726
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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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