MEDICARE: AGAINST ALL ODDS INTEGRATED COMMUNITY CARE

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
1	106S00000X	Behavior Technician		AZ
2	101Y00000X	Counselor		AZ

General Provider Information

NPI Number	:	1457879363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAINST ALL ODDS INTEGRATED COMMUNITY CARE

Provider Business Mailing Address
First Line	:	3005 E SUPERIOR RD
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-4580
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3707 E SOUTHERN AVE STE 1015
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-6201
Country	:	US
Telephone Number	:	602-397-9737
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. RANDY VELT WESLEY JR.
Credential	:
Telephone Number	:	602-397-9737

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	05/23/2023

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Directions to “AGAINST ALL ODDS INTEGRATED COMMUNITY CARE ” Practice Location

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