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General NPI Number Information
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NPI Number | 1669974853
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Entity Type | Organization
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Legal Business Name | PHOENIX ALLIES FOR COMMUNITY HEALTH
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 03/02/2018
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Provider Practice Location Address
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Address Line | 2902 W CLARENDON AVE
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City | PHOENIX
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State | AZ
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Zip | 85017-4609
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Country | US
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Telephone | 623-455-6470
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Fax |
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Provider Business Mailing Address
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Address Line | 2902 W CLARENDON AVE
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City | PHOENIX
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State | AZ
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Zip | 85017-4609
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JASON ANTHONY ODHNER
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Credential | RN
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Telephone | 602-762-1975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1000X
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Taxonomy Name | Migrant Health Clinic/Center
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License Number | OTC7852
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License Number State | AZ
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