Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
IDRIS ROBERSON
Active Sole ProprietorIDRIS ROBERSON is a Emotionally Disturbed Children Residential Treatment healthcare provider located in GLENDALE, Arizona. NPI 1639957277 is currently active in the NPPES registry. Verify at CMS.
Emotionally Disturbed Children Residential Treatment · GLENDALE, AZ
Registration Details
- NPI Number
- 1639957277
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Sep 15, 2023 (2.9583239937553 yrs)
- Last Updated
- Sep 15, 2023
- License
-
221509-14979 (AZ)
- Sole Proprietor
- Yes
Practice Information
- Address
-
4494 W PEORIA AVE STE 101GLENDALE, AZ, 853022024Browse AZ providers · Browse ZIP 85302
- Phone
- 6026872043
- Fax
- 6234404285
- Primary Specialty
-
Emotionally Disturbed Children Residential Treatment
320900000X
- Additional Specialty
- Emotionally Disturbed Children Residential Treatment
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.