Healthcare Provider Details

I. General information

NPI: 1588301014
Provider Name (Legal Business Name): BLESSED BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 N 59TH AVE
PHOENIX AZ
85033-4105
US

IV. Provider business mailing address

4007 N 59TH AVE
PHOENIX AZ
85033-4105
US

V. Phone/Fax

Practice location:
  • Phone: 520-445-5832
  • Fax:
Mailing address:
  • Phone: 520-445-5832
  • 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: NAIM SAITI
Title or Position: OWNER
Credential:
Phone: 602-320-8496