Provider Demographics
NPI:1144665092
Name:NAZCARE, INC - AMBITION WELLNESS CENTER
Entity type:Organization
Organization Name:NAZCARE, INC - AMBITION WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-442-9205
Mailing Address - Street 1:599 WHITE SPAR RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4627
Mailing Address - Country:US
Mailing Address - Phone:928-442-9505
Mailing Address - Fax:602-535-3230
Practice Address - Street 1:619 W DESMOND ST
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-2423
Practice Address - Country:US
Practice Address - Phone:928-442-9205
Practice Address - Fax:602-535-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty