Provider Demographics
NPI:1477916203
Name:STEP UP ARIZONA
Entity Type:Organization
Organization Name:STEP UP ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:623-466-7233
Mailing Address - Street 1:8466 W PEORIA AVE
Mailing Address - Street 2:#6
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6548
Mailing Address - Country:US
Mailing Address - Phone:623-466-7233
Mailing Address - Fax:
Practice Address - Street 1:8466 W PEORIA AVE
Practice Address - Street 2:#6
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6548
Practice Address - Country:US
Practice Address - Phone:623-466-7233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSLG7614251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health