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General NPI Number Information
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NPI Number | 1245015080
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Entity Type | Organization
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Legal Business Name | WILWAMH CARE LLC
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Dates
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Enumeration Date | 08/29/2023
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 6705 E FLYNN AVE
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City | FLORENCE
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State | AZ
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Zip | 85132-5110
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Country | US
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Telephone | 480-787-6790
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Fax |
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Provider Business Mailing Address
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Address Line | 619 E LESLIE AVE
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-4148
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Country | US
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Telephone | 508-423-9444
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WILSON KAHUNYO
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Credential | CEO
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Telephone | 508-423-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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