| Success Residence Llc | |
|
5120 E Wallace Way San Tan Valley AZ 85143-5161 | |
| (917) 891-4320 | |
| Not Available |
| Full Name | Success Residence Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 5120 E Wallace Way, San Tan Valley, Arizona |
| Authorized Official Name and Position | Maama Abukari (ADMINISTRATOR) |
| 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: (917) 891-4320 | Success Residence Llc 5120 E Wallace Way San Tan Valley AZ 85143-5161 Ph: (917) 891-4320 |
| NPI Number | 1225621485 |
|---|---|
| Provider Enumeration Date | 02/18/2021 |
| Last Update Date | 02/18/2021 |
| Certification Date | 02/18/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225621485 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
News Archive
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