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General NPI Number Information
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NPI Number | 1801545850
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Entity Type | Organization
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Legal Business Name | AZ FAMILIES CO-OP LLC
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Dates
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Enumeration Date | 03/18/2022
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 4391 EAST MARSHALL CT
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City | GILBERT
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State | AZ
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Zip | 85297
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Country | US
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Telephone | 855-755-2932
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Fax | 855-755-2932
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Provider Business Mailing Address
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Address Line | 5425 E BROADWAY BLVD # 286
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City | TUCSON
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State | AZ
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Zip | 85711-3704
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Country | US
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Telephone | 855-755-2932
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Fax | 855-755-2932
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Authorized Official
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Title or Position | PARTNER
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Name | MR. REX ROGER MATTHEWS
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Credential |
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Telephone | 855-755-2932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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