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General NPI Number Information
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NPI Number | 1790401388
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Entity Type | Organization
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Legal Business Name | CENTER STREET
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 5949 W NORTHERN AVE STE 201
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City | GLENDALE
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State | AZ
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Zip | 85301-7829
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Country | US
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Telephone | 323-233-1675
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Fax |
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Provider Business Mailing Address
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Address Line | 2739 W RANCHO DR
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City | PHOENIX
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State | AZ
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Zip | 85017-2645
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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 | OWNER
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Name | NILAH EMAGE ASY JAMIE QUINONES
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Credential |
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Telephone | 323-316-7585
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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