Provider Demographics
NPI:1033564042
Name:ARIZONA THERAPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ARIZONA THERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LANDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-399-8735
Mailing Address - Street 1:18444 N 25TH AVE
Mailing Address - Street 2:SUITE 420-712
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1261
Mailing Address - Country:US
Mailing Address - Phone:480-244-3586
Mailing Address - Fax:
Practice Address - Street 1:18444 N 25TH AVE
Practice Address - Street 2:SUITE 420-712
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-1261
Practice Address - Country:US
Practice Address - Phone:480-244-3586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children