# SUCCESS BEHAVIORAL GROUP HOME LLC 1

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588524110
- **Authorized official:** EWOMAZINO JOY OMASERE (ADMINISTRATOR)
- **Authorized official phone:** (903) 917-8122

## Contact information

- **Practice address:** 9557 W AGORA LN, TOLLESON, AZ 85353-4565
- **Practice address phone:** (602) 558-5847
- **Practice address fax:** (602) 671-6752
- **Mailing address:** 9557 W AGORA LN, TOLLESON, AZ 85353-4565
- **Mailing address phone:** (602) 558-5847
- **Mailing address fax:** (602) 671-6752

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/15/2025
- **Last updated:** 11/15/2025