Organization
LOLOMA HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA HORNBACK (OWNER/ADMINISTRATIVE OFFICER)
(623) 418-6657
Entity
Organization
Contact information
Practice address
7402 W SHANGRI LA RD, PEORIA, AZ 85345-5812
(623) 418-6657
Mailing address
7402 W SHANGRI LA RD, PEORIA, AZ 85345-5812
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4687
AZ
Other
Enumeration date
11/16/2015
Last updated
11/16/2015
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