Prosper Az
Community/Behavioral Health in Avondale, AZ. Organization (NPI-2).
NPI number1982201299
StatusActive
Last updated in NPPESOct 27, 2021
Details
- NPI
- 1982201299
- Entity type
- Organization (NPI-2)
- Legal business name
- Prosper Az
- Organization subpart
- No
- Enumeration date
- Oct 8, 2020
- Certification date
- Oct 27, 2021
- Last updated
- Oct 27, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
Practice location
10750 W McDowell RdAvondale, AZ 85392-5960
Phone 602-899-3015
Mailing address
10750 W McDowell Rd Ste C301Avondale, AZ 85392-5964
Phone 623-755-5679
Authorized official
Elonda Wilson
Administrator
6028993015
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