Provider Demographics
NPI:1275208746
Name:THE IGNITE CARE GROUP, PLLC
Entity Type:Organization
Organization Name:THE IGNITE CARE GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MISS
Authorized Official - First Name:KETURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-866-5726
Mailing Address - Street 1:875 S ESTRELLA PKWY UNIT 7823
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-8614
Mailing Address - Country:US
Mailing Address - Phone:832-866-5726
Mailing Address - Fax:
Practice Address - Street 1:12175 W MCDOWELL RD APT 1218
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5303
Practice Address - Country:US
Practice Address - Phone:832-866-5726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health