Healthcare Provider Details

I. General information

NPI: 1417818196
Provider Name (Legal Business Name): PSALMS MANOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 S 74TH DR
LAVEEN AZ
85339-5087
US

IV. Provider business mailing address

7108 S 74TH DR
LAVEEN AZ
85339-5087
US

V. Phone/Fax

Practice location:
  • Phone: 951-497-9974
  • Fax:
Mailing address:
  • Phone: 951-497-9974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROSE IFEACHO
Title or Position: CEO
Credential:
Phone: 951-497-9974