MEDICARE: ACOMA BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	324500000X	Substance Abuse Rehabilitation Facility
2	251B00000X	Case Management Agency
3	3104A0625X	Assisted Living Facility (Mental Illness)
4	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
5	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1972119733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACOMA BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	3437 W ACOMA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-5620
Country	:	US
Telephone Number	:	602-888-6779
Fax Number	:

Provider Business Practice Location Address
First Line	:	3437 W ACOMA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-5620
Country	:	US
Telephone Number	:	602-888-6779
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RWABUNEZA VIOLET MUSTARI
Credential	:
Telephone Number	:	949-449-4140

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	09/17/2020

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Directions to “ACOMA BEHAVIORAL HEALTH LLC ” Practice Location

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