Provider Demographics
NPI:1407006943
Name:ZAREPHATH
Entity Type:Organization
Organization Name:ZAREPHATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BHT
Authorized Official - Phone:480-518-6826
Mailing Address - Street 1:3524 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4206
Mailing Address - Country:US
Mailing Address - Phone:480-518-6826
Mailing Address - Fax:480-361-9144
Practice Address - Street 1:1701 S CACTUS RD
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85219-7730
Practice Address - Country:US
Practice Address - Phone:480-518-6826
Practice Address - Fax:480-361-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-20
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSA08ADHS01914385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child