Healthcare Provider Details

I. General information

NPI: 1922473255
Provider Name (Legal Business Name): KEWALA CORPORATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2015
Last Update Date: 12/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10829 E VERBINA LN
FLORENCE AZ
85132-7312
US

IV. Provider business mailing address

10829 E VERBINA LN
FLORENCE AZ
85132-7312
US

V. Phone/Fax

Practice location:
  • Phone: 623-703-8083
  • Fax: 520-447-7709
Mailing address:
  • Phone: 623-703-8083
  • Fax: 520-447-7709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberBH4748
License Number StateAZ

VIII. Authorized Official

Name: KEHINDE LAWAL
Title or Position: ADMINISTRATOR
Credential:
Phone: 623-703-8083