Healthcare Provider Details

I. General information

NPI: 1912772278
Provider Name (Legal Business Name): HARAMBEE HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5402 N RATTLER WAY
LITCHFIELD PARK AZ
85340-4166
US

IV. Provider business mailing address

5402 N RATTLER WAY
LITCHFIELD PARK AZ
85340-4166
US

V. Phone/Fax

Practice location:
  • Phone: 623-850-1113
  • Fax:
Mailing address:
  • Phone: 623-850-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TAMMIE FLOWERS
Title or Position: CEO
Credential:
Phone: 480-440-4246