MEDICARE: THE ADAM DIXON PERSEVERANCE FOUNDATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	101YM0800X	Mental Health Counselor
3	251C00000X	Developmentally Disabled Services Day Training Agency
4	251S00000X	Community/Behavioral Health Agency
5	261QA0600X	Adult Day Care Clinic/Center
6	261QH0100X	Health Service Clinic/Center
7	261QM0855X	Adolescent and Children Mental Health Clinic/Center
8	320800000X	Mental Illness Community Based Residential Treatment Facility
9	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1386267706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ADAM DIXON PERSEVERANCE FOUNDATION

Provider Business Mailing Address
First Line	:	5060 N 19TH AVE # 300-14
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-3210
Country	:	US
Telephone Number	:	480-560-6370
Fax Number	:

Provider Business Practice Location Address
First Line	:	5060 N 19TH AVE # 300-14
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-3210
Country	:	US
Telephone Number	:	480-560-6370
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ADAM CONLEY DIXON
Credential	:
Telephone Number	:	480-560-6370

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	05/20/2020

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Directions to “THE ADAM DIXON PERSEVERANCE FOUNDATION ” Practice Location

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