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General NPI Number Information
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NPI Number | 1922473255
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Entity Type | Organization
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Legal Business Name | KEWALA CORPORATIONS
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Dates
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Enumeration Date | 12/12/2015
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Last Update Date | 12/12/2015
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Provider Practice Location Address
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Address Line | 10829 E VERBINA LN
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City | FLORENCE
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State | AZ
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Zip | 85132-7312
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Country | US
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Telephone | 623-703-8083
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Fax | 520-447-7709
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Provider Business Mailing Address
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Address Line | 10829 E VERBINA LN
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City | FLORENCE
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State | AZ
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Zip | 85132-7312
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Country | US
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Telephone | 623-703-8083
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Fax | 520-447-7709
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KEHINDE LAWAL
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Credential |
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Telephone | 623-703-8083
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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 | BH4748
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License Number State | AZ
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