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General NPI Number Information
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NPI Number | 1962298141
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Entity Type | Organization
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Legal Business Name | MWCGP OUTPATIENT CARE, INC
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 8650 N 35TH AVE STE 105
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City | PHOENIX
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State | AZ
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Zip | 85051-3835
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Country | US
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Telephone | 262-748-2596
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Fax |
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Provider Business Mailing Address
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Address Line | 8828 S SANTA ELIZABETH DR
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City | GOODYEAR
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State | AZ
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Zip | 85338-7013
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Country | US
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Telephone | 262-748-2596
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOSIA KING
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Credential |
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Telephone | 262-748-2596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #4
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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 #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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