Provider Demographics
NPI:1639384282
Name:GUTHRIE MAINSTREAM SERVICES LLC
Entity Type:Organization
Organization Name:GUTHRIE MAINSTREAM SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-633-8881
Mailing Address - Street 1:727 S EXTENSION RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-2212
Mailing Address - Country:US
Mailing Address - Phone:480-633-8881
Mailing Address - Fax:480-633-7095
Practice Address - Street 1:727 S EXTENSION RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2212
Practice Address - Country:US
Practice Address - Phone:480-633-8881
Practice Address - Fax:480-633-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7933374251C00000X, 251E00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251E00000XAgenciesHome Health
Not Answered347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7933374OtherAHCCCS PROVIDER ID