Provider Demographics
NPI:1174661078
Name:ABILITY360, INC,
Entity type:Organization
Organization Name:ABILITY360, INC,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PANGRAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-256-2245
Mailing Address - Street 1:5025 E WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-7439
Mailing Address - Country:US
Mailing Address - Phone:602-256-2245
Mailing Address - Fax:602-528-3422
Practice Address - Street 1:5025 E WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-7439
Practice Address - Country:US
Practice Address - Phone:602-256-2245
Practice Address - Fax:602-528-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ131516320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities