MEDICARE: NI'LEE 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1578279675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NI'LEE TREATMENT CENTER LLC

Provider Business Mailing Address
First Line	:	7939 W ORANGE DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-5563
Country	:	US
Telephone Number	:	602-783-9846
Fax Number	:

Provider Business Practice Location Address
First Line	:	7939 W ORANGE DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-5563
Country	:	US
Telephone Number	:	602-783-9846
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ESSENCE BOLDEN
Credential	:
Telephone Number	:	602-783-9846

Provider Enumeration Date	:	01/24/2023
Last Update Date	:	01/24/2023

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