Provider Demographics
NPI:1457879363
Name:AGAINST ALL ODDS INTEGRATED COMMUNITY CARE
Entity Type:Organization
Organization Name:AGAINST ALL ODDS INTEGRATED COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:VELT
Authorized Official - Last Name:WESLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:602-397-9737
Mailing Address - Street 1:3005 E SUPERIOR RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-4580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3707 E SOUTHERN AVE STE 1015
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6201
Practice Address - Country:US
Practice Address - Phone:602-397-9737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA EMPOWER ACADEMY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-31
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101Y00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty