Idris Roberson
Idris Roberson is an Intellectual and/or Developmental Disabilities Residential Treatment Facility in Glendale, Arizona. Practices as a sole proprietor. Licensed in Arizona.
- Licensed in
- AZ
- In the registry since
- 2023
- Specialties on file
- 2
Practice location Address checks out
4494 W Peoria Ave Ste 101Glendale, AZ 85302-2024
Phone: (602) 687-2043
Fax: (623) 440-4285
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Specialties & licences
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (primary) | Taxonomy 320900000X · Licence 221509-14979 (AZ) |
|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | Taxonomy 320600000X |
Record details
| NPI number | 1639957277 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | September 15, 2023 |
| Last updated in NPPES | September 15, 2023 |
| Certification date | September 15, 2023 |
| Mailing address | 4494 W Peoria Ave Ste 101, Glendale, AZ 85302-2024 |
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