Individual provider · NPI-1

Casondra Clark

Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities · Surprise, AZ

NPI number1558210658
StatusActive
Last updated in NPPESJan 22, 2026

Details

NPI
1558210658
Entity type
Individual (NPI-1)
Name
Casondra Clark
Sex
Female
Sole proprietor
Yes
Enumeration date
Jan 22, 2026
Certification date
Jan 22, 2026
Last updated
Jan 22, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities––Yes

Practice location

17874 W Bloomfield Rd
Surprise, AZ 85388-5619

Phone 480-465-2920

Mailing address

17874 W Bloomfield Rd
Surprise, AZ 85388-5619

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