Wallace's Place

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

WALLACE'S PLACE

Practice address

9636 W Oberlin Way
Peoria, AZ 85383-8750

Phone

(623) 203-1148

Fax

(623) 825-4639

NPI assigned

Mar 15, 2008

Last updated

Mar 15, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Cynthia Lynn Clark, BSN RNC

Title

Executive Director

Phone

(623) 203-1148

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205539200000",
    "number": "1649441866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9636 W OBERLIN WAY",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853838750",
            "telephone_number": "623-203-1148",
            "fax_number": "623-825-4639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9636 W OBERLIN WAY",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853838750",
            "telephone_number": "623-203-1148",
            "fax_number": "623-825-4639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE'S PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-15",
        "last_updated": "2008-03-15",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "623-203-1148",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BSN RNC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "304367",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Traylor Walker, O.D.
• Lisa Ann Walker
• Robert Caleb Walker, PTA
• Tara Walker, DA
• Starla Wallace, PHARMD
• Brandon Walls
• Erica Walls, LCSW
• Walmart Inc. (Walmart Pharmacy 10-1533)
• Walmart Inc. (Walmart Pharmacy 10-3896)
• Walmart Inc. (WalMart Pharmacy 10-4275)

• Community/Behavioral Health Agency in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Community/Behavioral Health Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.