MEDICARE: ASPIRING ANEW GENERATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	106S00000X	Behavior Technician
3	251S00000X	Community/Behavioral Health Agency
4	251V00000X	Voluntary or Charitable Agency
5	3245S0500X	Children's Substance Abuse Rehabilitation Facility
6	385HR2055X	Child Mental Illness Respite Care
7	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1780342998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRING ANEW GENERATION

Provider Business Mailing Address
First Line	:	8607 N 59TH AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-5433
Country	:	US
Telephone Number	:	480-799-5345
Fax Number	:

Provider Business Practice Location Address
First Line	:	8607 N 59TH AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-5433
Country	:	US
Telephone Number	:	480-799-5345
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	JESSICA STANFORD
Credential	:
Telephone Number	:	480-799-5345

Provider Enumeration Date	:	12/04/2021
Last Update Date	:	12/04/2021

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