Provider Demographics
NPI:1609376698
Name:AGNES' CENTERS FOR DOMESTIC SOLUTIONS
Entity Type:Organization
Organization Name:AGNES' CENTERS FOR DOMESTIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:CROCKETT-SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-664-6554
Mailing Address - Street 1:455 S 48TH STREET
Mailing Address - Street 2:106
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281
Mailing Address - Country:US
Mailing Address - Phone:480-664-6554
Mailing Address - Fax:
Practice Address - Street 1:455 S 48TH STREET
Practice Address - Street 2:106
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281
Practice Address - Country:US
Practice Address - Phone:480-664-6554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health