Healthcare Provider Details

I. General information

NPI: 1366103780
Provider Name (Legal Business Name): DESERT ANGELS BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/07/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42131 W ROJO ST
MARICOPA AZ
85138-2582
US

IV. Provider business mailing address

25210 S WYOMING AVE
SUN LAKES AZ
85248-6408
US

V. Phone/Fax

Practice location:
  • Phone: 480-494-1419
  • Fax: 800-758-1538
Mailing address:
  • Phone:
  • 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
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JACQUELYN AWOSIKA
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 480-494-1419