Provider Demographics
NPI:1720661788
Name:1ST STEP THE CAMBRIDGE LLC
Entity Type:Organization
Organization Name:1ST STEP THE CAMBRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:ODETTE
Authorized Official - Last Name:GUAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-298-2816
Mailing Address - Street 1:17916 N 93RD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6030
Mailing Address - Country:US
Mailing Address - Phone:480-298-2816
Mailing Address - Fax:
Practice Address - Street 1:3509 E CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-1219
Practice Address - Country:US
Practice Address - Phone:480-298-2816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness