101 Wall Support Services LLC
Organization Active NPI Community/Behavioral Health Agency · Mesa, AZ
NPI 1568804342 · NPPES record last updated Jul 23, 2013
Key facts
- NPI
- 1568804342
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- License
- BH-4204 (AZ)
- Legal business name
- 101 WALL SUPPORT SERVICES LLC
- Practice address
- 919 N Stapley Dr
Suite M
Mesa, AZ 85203-5639 - Phone
- (480) 285-9426
- Fax
- (480) 907-1358
- NPI assigned
- Jul 23, 2013
- Organization subpart
- No
Authorized official
- Name
- Mr. Jonathan Christain Taylor
- Title
- Chief Executive Officer
- Phone
- (480) 285-9426
National Provider Directory
Locations
919 N Stapley Dr
Ste M
Mesa, AZ 85203
Phone (480) 285-9426
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | BH-4204 | AZ | Yes |
Addresses
Primary practice location
919 N Stapley Dr
Suite M
Mesa, AZ 85203-5639
Mailing address
919 N Stapley Dr
Suite M
Mesa, AZ 85203-5639
Phone (480) 285-9426
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.