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General NPI Number Information
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NPI Number | 1639531072
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Entity Type | Organization
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Legal Business Name | DOVE IN THE VALLEY LLC
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 10/11/2018
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Provider Practice Location Address
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Address Line | 6812 S 21ST DR
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City | PHOENIX
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State | AZ
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Zip | 85041-6561
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Country | US
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Telephone | 602-268-6554
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Fax |
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Provider Business Mailing Address
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Address Line | 5450 W WHITTEN ST
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City | CHANDLER
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State | AZ
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Zip | 85226-7813
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Country | US
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Telephone | 480-616-3858
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARIE HORTENSE TIOKOU
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Credential | RN
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Telephone | 480-616-3858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | BH4783
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License Number State | AZ
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