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General NPI Number Information
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NPI Number | 1912692492
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Entity Type | Organization
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Legal Business Name | PROVIDENCE BHF LLC
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 1135 E SADDLE BACK PLACE
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143
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Country | US
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Telephone | 973-807-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 21168 E OCOTILLO RD # 1149
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-8175
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Country | US
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Telephone | 973-807-8333
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JESSICA ROSA ARAUJO
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Credential |
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Telephone | 973-807-8333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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