Organization
LEGACY HEALING HEALTH COMMUNTY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOSES NTIRENGANYA (CEO)
(480) 692-0247
Entity
Organization
Contact information
Practice address
1526 W GLENDALE AVE STE 109, PHOENIX, AZ 85021-8576
(480) 692-0247
Mailing address
5203 N 22ND AVE, PHOENIX, AZ 85015-2815
(480) 692-0247
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/12/2022
Last updated
04/23/2022
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