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Organization
DW DEVELOPMENTAL HOMES LLC
Active
Organization
DW DEVELOPMENTAL HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMONA SHALLESE WILFRED (CEO)
(951) 377-2710
Entity
Organization
Contact information
Practice address
2609 NORTH 107TH AVE, AVONDALE, AZ 85353
(951) 377-2710
Mailing address
9035 W GLOBE AVE, TOLLESON, AZ 85353-8642
(951) 377-2710
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000000
—
AZ
Enumeration date
05/06/2022
Last updated
05/06/2022
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