Provider Demographics
NPI:1063002509
Name:MY CITY RADIUS COMMUNITY HEALTH SERVICES
Entity type:Organization
Organization Name:MY CITY RADIUS COMMUNITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:USIGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-341-3863
Mailing Address - Street 1:6125 S ASH AVE STE B-7
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5608
Mailing Address - Country:US
Mailing Address - Phone:602-341-3863
Mailing Address - Fax:
Practice Address - Street 1:6125 S ASH AVE STE B-7
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5608
Practice Address - Country:US
Practice Address - Phone:602-341-3863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health