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General NPI Number Information
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NPI Number | 1477203776
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Entity Type | Organization
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Legal Business Name | AZ SOCIAL SERVICE
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Dates
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Enumeration Date | 03/28/2022
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 2205 EDINBURGH WAY
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City | GARLAND
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State | TX
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Zip | 75040-1139
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Country | US
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Telephone | 972-494-5515
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Fax | 214-227-5448
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Provider Business Mailing Address
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Address Line | 2205 EDINBURGH WAY
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City | GARLAND
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State | TX
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Zip | 75040-1139
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Country | US
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Telephone | 972-494-5515
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Fax | 214-227-5448
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | VICTOR NWAOKOLO
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Credential | LMSW/IPR
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Telephone | 979-494-5515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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