Organization
THE HERITAGE BEHAVIORAL HEALTH HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRISTEN SMITH (DIRECTOR OF OPERATIONS)
(973) 270-4676
Entity
Organization
Contact information
Practice address
3927 W ROVEY AVE, PHOENIX, AZ 85019-1633
(602) 675-3975
Mailing address
3927 W ROVEY AVE, PHOENIX, AZ 85019-1633
(973) 452-2505
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000000
—
AZ
Enumeration date
07/29/2020
Last updated
08/12/2020
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