Provider Demographics
NPI:1922798677
Name:PARENT INFORMATION DISTRIBUTION CENTER, INC
Entity Type:Organization
Organization Name:PARENT INFORMATION DISTRIBUTION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HULL-BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-383-0375
Mailing Address - Street 1:15887 W LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-4158
Mailing Address - Country:US
Mailing Address - Phone:623-383-0375
Mailing Address - Fax:
Practice Address - Street 1:2219 S 48TH ST STE I&J
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1010
Practice Address - Country:US
Practice Address - Phone:623-383-0375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency