Healthcare Provider Details

I. General information

NPI: 1972195428
Provider Name (Legal Business Name): ADORA HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 E CHOLLA ST
PHOENIX AZ
85028-1917
US

IV. Provider business mailing address

3045 E CHOLLA ST
PHOENIX AZ
85028-1917
US

V. Phone/Fax

Practice location:
  • Phone: 216-544-5418
  • Fax: 623-251-7452
Mailing address:
  • Phone: 216-544-5418
  • Fax: 623-251-7452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: PETER TAMUNOH TEBOH
Title or Position: CEO
Credential: FNP-BC
Phone: 216-544-5418