Healthcare Provider Details

I. General information

NPI: 1912349440
Provider Name (Legal Business Name): VEMA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7032 W SIERRA ST
PEORIA AZ
85345-8719
US

IV. Provider business mailing address

3927 W CHOLLA ST
PHOENIX AZ
85029-3813
US

V. Phone/Fax

Practice location:
  • Phone: 602-298-2540
  • Fax:
Mailing address:
  • Phone: 602-298-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberBH4156
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberBH4156
License Number StateAZ

VIII. Authorized Official

Name: RUDY VEGA
Title or Position: CEO
Credential:
Phone: 602-298-2540