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General NPI Number Information
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NPI Number | 1982347571
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Entity Type | Organization
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Legal Business Name | HEALING ARMS OF LOVE BEHAVIORAL LLC
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 1689 E MELANIE ST
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-5832
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Country | US
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Telephone | 480-329-0820
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Fax |
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Provider Business Mailing Address
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Address Line | 1689 E MELANIE ST
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-5832
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GLADYS KWAMBOKA
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Credential |
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Telephone | 480-329-0820
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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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