Organization · NPI-2

101 Wall Support Services LLC

Community/Behavioral Health · Mesa, AZ

NPI number1568804342
StatusActive
Last updated in NPPESJul 23, 2013

Details

NPI
1568804342
Entity type
Organization (NPI-2)
Legal business name
101 Wall Support Services LLC
Organization subpart
No
Enumeration date
Jul 23, 2013
Last updated
Jul 23, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
251S00000X Community/Behavioral HealthBH-4204AZYes

Practice location

919 N Stapley Dr
Suite M
Mesa, AZ 85203-5639

Phone 480-285-9426 · Fax 480-907-1358

Mailing address

919 N Stapley Dr
Suite M
Mesa, AZ 85203-5639

Phone 480-285-9426 · Fax 480-907-1358

Authorized official

Jonathan Christain Taylor
Chief Executive Officer
4802859426

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