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NPI Code Detail

MEDICARE: IDEAL TREATMENT CENTER LLC

MEDICARE: IDEAL TREATMENT CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1336837616
Entity Type Code : Organization
Provider Name (Legal Business Name) : IDEAL TREATMENT CENTER LLC
Provider Business Mailing Address
First Line : 1717 W NORTHERN AVE STE 107
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-5400
Country : US
Telephone Number : 602-612-2305
Fax Number :
Provider Business Practice Location Address
First Line : 1717 W NORTHERN AVE STE 107
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-5400
Country : US
Telephone Number : 602-612-2305
Fax Number :
Authorized Official
Title or Position : NURSE PRACTITIONER
Name : AIMEE UWIMANA
Credential : DNP
Telephone Number : 602-399-0134
Provider Enumeration Date : 04/25/2023
Last Update Date : 06/19/2026

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Directions to “IDEAL TREATMENT CENTER LLC ” Practice Location

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