Individual provider · Type 1 NPI
Casondra Clark
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Surprise, AZ
Practice location
17874 W Bloomfield Rd
Surprise, AZ 85388-5619
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary | 320900000X | None listed |
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
About NPI 1558210658
Casondra Clark's National Provider Identifier is 1558210658, issued on Jan 22, 2026. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Surprise, AZ. The record was last updated on Jan 22, 2026.