| Success Residence Llc | |
|
2408 E Olivine Rd San Tan Valley AZ 85143-4908 | |
| (917) 891-4320 | |
| Not Available |
| Full Name | Success Residence Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2408 E Olivine Rd, San Tan Valley, Arizona |
| Authorized Official Name and Position | Maama Abukari (EMPLOYEE) |
| Authorized Official Contact | 9178914320 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Success Residence Llc 5120 E Wallace Way San Tan Valley AZ 85143-5161 Ph: () - | Success Residence Llc 2408 E Olivine Rd San Tan Valley AZ 85143-4908 Ph: (917) 891-4320 |
| NPI Number | 1033803309 |
|---|---|
| Provider Enumeration Date | 06/08/2023 |
| Last Update Date | 06/08/2023 |
| Certification Date | 06/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033803309 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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