Basic Information
| Provider Information | |||||||||
| NPI: | 1871823260 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY PROVIDER OF ENRICHMENT SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 E MCDOWELL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062611 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1110 E MCDOWELL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026851940 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2010 | ||||||||
| LastUpdateDate: | 01/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | LUEHRING | ||||||||
| AuthorizedOfficialFirstName: | MATHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONSULTANT | ||||||||
| AuthorizedOfficialTelephone: | 6022927563 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.