Organization
MON AMI GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SALIM OTIENO ODIERO CEO (ADMINISTRATOR)
(503) 805-9203
Entity
Organization
Contact information
Practice address
9138 E DENNIS ST, MESA, AZ 85207-6008
(480) 380-4413
Mailing address
9138 E DENNIS ST, MESA, AZ 85207-6008
(480) 380-4413
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/14/2019
Last updated
06/10/2020
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