person
Idris Roberson
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Glendale, Arizona
NPI 1639957277

Idris Roberson is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Glendale, AZ. Idris Roberson practices in Glendale, AZ. The NPI Number for Idris Roberson is 1639957277 and holds a License No. (Arizona).

The current practice location address for Idris Roberson is 4494 W Peoria Ave Ste 101, Glendale, AZ and can be reached out via phone at 602-687-2043 and via fax at 623-440-4285.

Location: 4494 W Peoria Ave Ste 101, Glendale, AZ, 85302-2024
person
Provider Profile Details
NPI Number
1639957277
Provider Name
Idris Roberson
Credential
Provider Entity Type
Individual
Gender
Male
Address
4494 W Peoria Ave Ste 101, Glendale, AZ, 85302-2024
Phone Number
602-687-2043
Fax Number
623-440-4285
Provider Enumeration Date
09/15/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
4494 W Peoria Ave Ste 101
City
State
Zip
85302-2024
Phone Number
602-687-2043
Fax Number
623-440-4285
person
Provider Business Mailing Address Details
Address
4494 W Peoria Ave Ste 101
City
State
Zip
85302-2024
Phone Number
602-687-2043
Fax Number
623-440-4285
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
License No.
221509-14979 (Arizona)
Definition
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
person
Provider's Taxonomy Details 2
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
License No.
()
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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