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General NPI Number Information
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NPI Number | 1639775000
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Entity Type | Organization
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Legal Business Name | BEKA'S COMFORT HOME
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 4015 W SALTER DR
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City | GLENDALE
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State | AZ
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Zip | 85308-2078
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Country | US
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Telephone | 623-242-7752
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Fax |
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Provider Business Mailing Address
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Address Line | 4015 W SALTER DR
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City | GLENDALE
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State | AZ
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Zip | 85308-2078
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Country | US
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Telephone | 623-242-7752
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/MANAGER
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Name | DR. KERUBO HAPPINESS KINARO
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Credential |
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Telephone | 410-660-5117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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