Provider Demographics
NPI:1114039427
Name:GUTHRIE MAINSTREAM SERVICES
Entity Type:Organization
Organization Name:GUTHRIE MAINSTREAM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-633-8881
Mailing Address - Street 1:727 S EXTENSION RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-2212
Mailing Address - Country:US
Mailing Address - Phone:480-633-8881
Mailing Address - Fax:480-633-7095
Practice Address - Street 1:727 S EXTENSION RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2212
Practice Address - Country:US
Practice Address - Phone:480-633-8881
Practice Address - Fax:480-633-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ793374251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services