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General NPI Number Information
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NPI Number | 1619634458
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Entity Type | Organization
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Legal Business Name | SPLENDOR BEHAVIORAL RESIDENCY LLC
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 43842 W ELIZABETH AVE
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City | MARICOPA
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State | AZ
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Zip | 85138-5673
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Country | US
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Telephone | 713-291-1836
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Fax |
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Provider Business Mailing Address
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Address Line | 43842 W ELIZABETH AVE
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City | MARICOPA
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State | AZ
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Zip | 85138-5673
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Country | US
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Telephone | 713-291-1836
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | KASARACHI DARLYN EMEDORO
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Credential | B.S
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Telephone | 713-291-1836
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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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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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