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1939 Frontage Rd Sierra Vista AZ 85635-4638 | |
| (520) 330-1023 | |
| (928) 636-9904 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1939 Frontage Rd, Sierra Vista, Arizona |
| Authorized Official Name and Position | Jejj Kazmierczak (CEO) |
| Authorized Official Contact | 6022531240 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7816 N 19th Ave Phoenix AZ 85021-7036 Ph: (602) 253-1240 | 1939 Frontage Rd Sierra Vista AZ 85635-4638 Ph: (520) 330-1023 |
| NPI Number | 1902116312 |
|---|---|
| Provider Enumeration Date | 10/19/2010 |
| Last Update Date | 08/14/2024 |
| Certification Date | 08/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902116312 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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