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General NPI Number Information
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NPI Number | 1700549417
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Entity Type | Organization
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Legal Business Name | VALLEY HOME BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 3142 W MARSHALL AVE
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City | PHOENIX
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State | AZ
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Zip | 85017-2420
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Country | US
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Telephone | 773-766-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 3142 W MARSHALL AVE
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City | PHOENIX
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State | AZ
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Zip | 85017-2420
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Country | US
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Telephone | 773-766-1999
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PETER G MATOR JR.
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Credential |
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Telephone | 773-766-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State |
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