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General NPI Number Information
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NPI Number | 1497372908
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Entity Type | Organization
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Legal Business Name | A PATH OF RESILIENCE - APRBHS - ROSE HOUSE - LLC
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 2258 W WAYLAND RD
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City | PHOENIX
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State | AZ
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Zip | 85041-3753
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Country | US
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Telephone | 602-281-0704
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Fax |
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Provider Business Mailing Address
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Address Line | 2258 W WAYLAND RD
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City | PHOENIX
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State | AZ
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Zip | 85041-3753
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Country | US
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Telephone | 602-281-0704
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAROIE DAVIS
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Credential |
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Telephone | 602-281-0704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #6
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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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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #12
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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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