Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Idris Roberson

Individual provider Intellectual and/or Developmental Disabilities Residential Treatment Facility · NPI 1639957277

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 101
Glendale, AZ 85302-2024
Phone: (602) 687-2043
Fax: (623) 440-4285
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

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 number1639957277
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 15, 2023
Last updated in NPPESSeptember 15, 2023
Certification dateSeptember 15, 2023
Mailing address4494 W Peoria Ave Ste 101, Glendale, AZ 85302-2024

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