Provider Demographics
NPI:1013600956
Name:WEST PHOENIX COMMUNITY CARE
Entity type:Organization
Organization Name:WEST PHOENIX COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MATILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOACHIE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:860-967-2388
Mailing Address - Street 1:4525 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-2820
Mailing Address - Country:US
Mailing Address - Phone:860-967-2388
Mailing Address - Fax:
Practice Address - Street 1:4525 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-2820
Practice Address - Country:US
Practice Address - Phone:623-204-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health