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Ms. Diane Macon
Child Mental Illness Respite Care in Phoenix, Arizona
NPI 1003982703

Diane Macon is a Child Mental Illness Respite Care based in Phoenix, AZ and is specialized in Respite Care, Mental Illness, Child. Diane Macon practices in Phoenix, AZ. The NPI Number for Diane Macon is 1003982703 and holds a License No. 3870 (Arizona).

The current practice location address for Diane Macon is 1910 E Mobile Ln, Phoenix, AZ and can be reached out via phone at 602-268-4333.

Location: 1910 E Mobile Ln, Phoenix, AZ, 85066
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1003982703
Provider Name
Diane Macon
Credential
Provider Entity Type
Individual
Gender
Female
Address
1910 E Mobile Ln, Phoenix, AZ, 85066
Phone Number
602-268-4333
Fax Number
Provider Enumeration Date
11/27/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
714221 01 AZ AHCCCS ID NUMBER
institution
Provider Business Practice Location Address Details
Address
1910 E Mobile Ln
City
Phoenix
State
Arizona
Zip
85040-2439
Phone Number
602-268-4333
Fax Number
person
Provider Business Mailing Address Details
Address
1910 E Mobile Ln
City
Phoenix
State
Arizona
Zip
85040-2439
Phone Number
602-268-4333
Fax Number
person
Provider's Taxonomy Details 1
Type
Respite Care Facility
Classification
Respite Care
Speciality
Respite Care, Mental Illness, Child
Taxonomy
385HR2055X
License No.
3870 (Arizona)
Definition
A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers.
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