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General NPI Number Information
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NPI Number | 1972342251
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Entity Type | Organization
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Legal Business Name | STEP ONE HALFWAY HOUSE
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 9636 N 11TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85021-3004
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Country | US
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Telephone | 602-749-5434
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Fax |
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Provider Business Mailing Address
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Address Line | 9636 N 11TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85021-3004
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Country | US
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Telephone | 602-749-5434
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. SHELBY LEE
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Credential | BHT
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Telephone | 602-601-9254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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