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General NPI Number Information
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NPI Number | 1124776109
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Entity Type | Organization
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Legal Business Name | CANA BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 03/21/2022
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Provider Practice Location Address
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Address Line | 300 S MAIN ST STE 212
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-4201
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Country | US
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Telephone | 919-415-1212
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Fax | 919-415-1216
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Provider Business Mailing Address
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Address Line | 16165 N 83RD AVE STE 200
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City | PEORIA
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State | AZ
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Zip | 85382-5816
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Country | US
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Telephone | 919-415-1212
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Fax | 919-415-1216
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | LOLADE A OGUNLEYE
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Credential | MSN
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Telephone | 530-868-6944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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