Provider Demographics
NPI:1568947364
Name:AZ INTERACT LLC
Entity Type:Organization
Organization Name:AZ INTERACT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-518-9040
Mailing Address - Street 1:2325 W DESPERADO WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5777
Mailing Address - Country:US
Mailing Address - Phone:623-518-9040
Mailing Address - Fax:623-398-8980
Practice Address - Street 1:4656 W JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1500
Practice Address - Country:US
Practice Address - Phone:623-518-9040
Practice Address - Fax:623-398-8980
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AZ INTERACT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities