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General NPI Number Information
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NPI Number | 1497826101
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Entity Type | Organization
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Legal Business Name | CENTRO DE AMISTAD, INCORPRORADO
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 8202 S AVENIDA DEL YAQUI
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City | GUADALUPE
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State | AZ
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Zip | 85283-1024
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Country | US
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Telephone | 480-839-2926
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Fax | 480-839-9985
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Provider Business Mailing Address
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Address Line | 2923 N 33RD AVE
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City | PHOENIX
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State | AZ
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Zip | 85017-5201
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Country | US
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Telephone | 602-393-3840
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Fax | 602-393-3842
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MRS. RITA MONROY
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Credential |
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Telephone | 602-393-3840
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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 | BH-187
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License Number State | AZ
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