Provider Demographics
NPI:1760063770
Name:A & D ADULT AND YOUTH CENTER LLC
Entity Type:Organization
Organization Name:A & D ADULT AND YOUTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-877-1122
Mailing Address - Street 1:1002 E MCDOWELL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2624
Mailing Address - Country:US
Mailing Address - Phone:602-314-4218
Mailing Address - Fax:602-354-5842
Practice Address - Street 1:1002 E MCDOWELL RD STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2624
Practice Address - Country:US
Practice Address - Phone:602-314-4218
Practice Address - Fax:602-354-5842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)