Provider Demographics
NPI:1073147195
Name:ARMADA GROUP-AZ, LLC
Entity Type:Organization
Organization Name:ARMADA GROUP-AZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-805-3254
Mailing Address - Street 1:1612 E. KNOLL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203
Mailing Address - Country:US
Mailing Address - Phone:661-805-3254
Mailing Address - Fax:480-504-5961
Practice Address - Street 1:1612 E. KNOLL CIRCLE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203
Practice Address - Country:US
Practice Address - Phone:661-805-3254
Practice Address - Fax:480-504-5961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities