MEDICARE: LEVIS TREATMENT CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1285408526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEVIS TREATMENT CENTER LLC

Provider Business Mailing Address
First Line	:	1052 E WASHINGTON AVE
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-9014
Country	:	US
Telephone Number	:	480-906-7761
Fax Number	:	463-201-7899

Provider Business Practice Location Address
First Line	:	4530 E RAY RD STE 172
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-6099
Country	:	US
Telephone Number	:	480-906-7761
Fax Number	:	463-201-7899

Authorized Official
Title or Position	:	CEO
Name	:	ANITA MAWAZO
Credential	:
Telephone Number	:	480-906-7761

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	11/07/2023

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Directions to “LEVIS TREATMENT CENTER LLC ” Practice Location

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