Organization
NEW MERVEILLE 2 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DESIRE N NKOMEZI PHD (OWNER)
(817) 707-2798
Entity
Organization
Contact information
Practice address
4821 N 108TH AVE, PHOENIX, AZ 85037-5471
(817) 707-2798
Mailing address
4821 N 108TH AVE, PHOENIX, AZ 85037-5471
(817) 707-2798
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
09/10/2024
Last updated
02/20/2025
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