NPI 1780127241

Steven Illers

Practitioner Foster Care Agency Kingman, AZ

Practice location

Address: 3854 Heather Ave, Kingman, AZ 86401-3844
Phone: (702) 219-0881
Fax: (928) 774-2159

Registered specialties (2)

Foster Care Agency Primary

Agencies Taxonomy 253J00000X Licence 8122828 (AZ)

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Child Mental Illness Respite Care

Respite Care Facility Taxonomy 385HR2055X Licence 8122828 (AZ)

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Registry record

NPI: 1780127241
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Nov 2016
Record last updated: 4 Feb 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.