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General NPI Number Information
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NPI Number | 1578009759
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Entity Type | Organization
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Legal Business Name | PARK PLACE OUTREACH & COUNSELING CENTERS, INC.
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 15136 S AVALON RD
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City | ARIZONA CITY
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State | AZ
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Zip | 85123
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Country | US
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Telephone | 520-466-8850
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Fax | 520-466-8851
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Provider Business Mailing Address
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Address Line | P.O. BOX 2779
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City | ARIZONA CITY
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State | AZ
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Zip | 85123
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Country | US
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Telephone | 520-466-8850
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Fax | 520-466-8851
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RAYMOND EARNEST LINAFELTER
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Credential |
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Telephone | 520-466-8850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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