Provider Demographics
NPI:1881348548
Name:ANB LLC
Entity type:Organization
Organization Name:ANB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEI
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-277-5787
Mailing Address - Street 1:23335 N 18TH DR STE B124
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-6300
Mailing Address - Country:US
Mailing Address - Phone:602-277-5787
Mailing Address - Fax:602-883-7856
Practice Address - Street 1:23335 N 18TH DR STE B124
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-6300
Practice Address - Country:US
Practice Address - Phone:602-277-5787
Practice Address - Fax:602-883-7856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ094829Medicaid