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General NPI Number Information
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NPI Number | 1639821317
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Entity Type | Organization
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Legal Business Name | MUNGOH BC (MBC) LLC
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 24610 N SHELTON WAY
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City | FLORENCE
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State | AZ
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Zip | 85132-8018
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Country | US
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Telephone | 520-234-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 24610 N SHELTON WAY
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City | FLORENCE
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State | AZ
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Zip | 85132-8018
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Country | US
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Telephone | 520-324-1600
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MARY AKWAR
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Credential |
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Telephone | 480-234-1509
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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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