Provider Demographics
NPI:1528474533
Name:MARY FLANERY
Entity type:Organization
Organization Name:MARY FLANERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLANERY
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC
Authorized Official - Phone:520-466-8850
Mailing Address - Street 1:1365 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-3694
Mailing Address - Country:US
Mailing Address - Phone:520-466-8850
Mailing Address - Fax:520-466-8851
Practice Address - Street 1:1365 E 12TH ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-3694
Practice Address - Country:US
Practice Address - Phone:520-466-8850
Practice Address - Fax:520-466-8851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARY FLANERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSA1695320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness