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Organization
MOMS HOUSE OF AZ LLC
Active
Organization
MOMS HOUSE OF AZ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAREL HALL (OWNER)
(510) 368-0713
Entity
Organization
Contact information
Practice address
3636 N 3RD AVE STE 150, PHOENIX, AZ 85013-3943
(510) 386-0713
Mailing address
3636 N 3RD AVE STE 150, PHOENIX, AZ 85013-3943
(510) 386-0713
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
05/12/2020
Last updated
05/12/2020
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