Healthcare Provider Details

I. General information

NPI: 1073456570
Provider Name (Legal Business Name): GREAT VALLEY BEHAVIORAL HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5723 W PUEBLO AVE
PHOENIX AZ
85043-6404
US

IV. Provider business mailing address

7520 S ESTRELLA PKWY
GOODYEAR AZ
85338-7115
US

V. Phone/Fax

Practice location:
  • Phone: 480-232-8260
  • Fax: 602-225-2201
Mailing address:
  • Phone: 480-232-8260
  • Fax: 602-225-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHOLLETA WANJIRU MENJA
Title or Position: BHP
Credential: DNP,PMHNP-BC
Phone: 480-232-8260