Healthcare Provider Details

I. General information

NPI: 1083548481
Provider Name (Legal Business Name): AHAVA WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E THOMAS RD STE 102
PHOENIX AZ
85016-7948
US

IV. Provider business mailing address

2500 E THOMAS RD STE 102
PHOENIX AZ
85016-7948
US

V. Phone/Fax

Practice location:
  • Phone: 602-271-0053
  • Fax:
Mailing address:
  • Phone: 602-271-0053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: FRANKIE JONES
Title or Position: OWNER
Credential:
Phone: 602-920-1620