Provider Demographics
NPI:1679717441
Name:ARIZONA SUPPORT SERVICES AND INTENSIVE SKILLS TRAINING, INC.
Entity Type:Organization
Organization Name:ARIZONA SUPPORT SERVICES AND INTENSIVE SKILLS TRAINING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-443-9290
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:AZ
Mailing Address - Zip Code:86332-0300
Mailing Address - Country:US
Mailing Address - Phone:928-443-9290
Mailing Address - Fax:928-277-4806
Practice Address - Street 1:2957 N US HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-4963
Practice Address - Country:US
Practice Address - Phone:928-443-9290
Practice Address - Fax:928-277-4806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health