MEDICARE: 1ST STEP THE CAMBRIDGE 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
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1720661788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST STEP THE CAMBRIDGE LLC

Provider Business Mailing Address
First Line	:	17916 N 93RD ST
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-6030
Country	:	US
Telephone Number	:	480-298-2816
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 E CAMBRIDGE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-1219
Country	:	US
Telephone Number	:	480-298-2816
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	MRS. DIONNE ODETTE GUAJARDO
Credential	:
Telephone Number	:	480-298-2816

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	04/28/2021

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Directions to “1ST STEP THE CAMBRIDGE LLC ” Practice Location

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