Provider Demographics
NPI:1003138595
Name:NEXT LEVEL ADULT DEVELOPMENTAL CARE
Entity Type:Organization
Organization Name:NEXT LEVEL ADULT DEVELOPMENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PORCHEL
Authorized Official - Middle Name:DONTAE
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-790-7817
Mailing Address - Street 1:2324 W CARSON RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6408
Mailing Address - Country:US
Mailing Address - Phone:602-790-7817
Mailing Address - Fax:
Practice Address - Street 1:2324 W CARSON RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6408
Practice Address - Country:US
Practice Address - Phone:602-790-7817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04942385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child