MEDICARE: STEP ONE HALFWAY HOUSE

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1972342251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEP ONE HALFWAY HOUSE

Provider Business Mailing Address
First Line	:	9636 N 11TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-3004
Country	:	US
Telephone Number	:	602-749-5434
Fax Number	:

Provider Business Practice Location Address
First Line	:	9636 N 11TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-3004
Country	:	US
Telephone Number	:	602-749-5434
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. SHELBY LEE
Credential	:	BHT
Telephone Number	:	602-601-9254

Provider Enumeration Date	:	05/24/2024
Last Update Date	:	05/24/2024

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Directions to “STEP ONE HALFWAY HOUSE ” Practice Location

Language	Start Address	Practice Location

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