MEDICARE: DOVE IN THE VALLEY 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	261QM0850X	Adult Mental Health Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility	BH4783	AZ

General Provider Information

NPI Number	:	1639531072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOVE IN THE VALLEY LLC

Provider Business Mailing Address
First Line	:	5450 W WHITTEN ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-7813
Country	:	US
Telephone Number	:	480-616-3858
Fax Number	:

Provider Business Practice Location Address
First Line	:	6812 S 21ST DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6561
Country	:	US
Telephone Number	:	602-268-6554
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MARIE HORTENSE TIOKOU
Credential	:	RN
Telephone Number	:	480-616-3858

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	10/11/2018

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Directions to “DOVE IN THE VALLEY LLC ” Practice Location

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