Provider Demographics
NPI:1568693950
Name:RESILIENCY PROVIDER SERVICES
Entity Type:Organization
Organization Name:RESILIENCY PROVIDER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:EKANEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-483-3439
Mailing Address - Street 1:12312 W DELWOOD DR
Mailing Address - Street 2:PO BOX 3699
Mailing Address - City:ARIZONA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85223-5577
Mailing Address - Country:US
Mailing Address - Phone:520-483-3439
Mailing Address - Fax:520-437-0188
Practice Address - Street 1:12312 W DELWOOD DR
Practice Address - Street 2:
Practice Address - City:ARIZONA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85223-5577
Practice Address - Country:US
Practice Address - Phone:520-483-3439
Practice Address - Fax:520-437-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child