Healthcare Provider Details

I. General information

NPI: 1104667294
Provider Name (Legal Business Name): TOGETHER BHRF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10423 W EDGEMONT DR
AVONDALE AZ
85392-4652
US

IV. Provider business mailing address

10423 W EDGEMONT DR
AVONDALE AZ
85392-4652
US

V. Phone/Fax

Practice location:
  • Phone: 480-358-7850
  • Fax:
Mailing address:
  • Phone: 480-358-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MOJOK AJAWIN
Title or Position: OWNER
Credential:
Phone: 480-358-7850