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General NPI Number Information
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NPI Number | 1467198010
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Entity Type | Organization
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Legal Business Name | DW DEVELOPMENTAL HOMES LLC
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 2609 NORTH 107TH AVE
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City | AVONDALE
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State | AZ
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Zip | 85353
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Country | US
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Telephone | 951-377-2710
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Fax |
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Provider Business Mailing Address
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Address Line | 9035 W GLOBE AVE
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City | TOLLESON
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State | AZ
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Zip | 85353-8642
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Country | US
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Telephone | 951-377-2710
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SIMONA SHALLESE WILFRED
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Credential |
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Telephone | 951-377-2710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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