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General NPI Number Information
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NPI Number | 1760193742
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Entity Type | Organization
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Legal Business Name | NAZARENE RESTORATION HOUSE
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Dates
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Enumeration Date | 12/09/2022
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 2450 W GLENROSA AVE UNIT 24
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City | PHOENIX
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State | AZ
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Zip | 85015-4989
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Country | US
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Telephone | 602-612-4837
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 W GLENROSA AVE UNIT 24
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City | PHOENIX
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State | AZ
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Zip | 85015-4989
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Country | US
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Telephone | 602-612-4837
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. TRACEY DAVIS
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Credential |
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Telephone | 602-612-4837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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