Organization
ANGEL HEART BEHAVIORAL HEALTH III LLC
Active
Other names
ANGEL HEART BEHAVIORAL HEALTH III LLC
Organization subpart
No
Provider details
NPI number
Authorized official
AIMEE NYIRAKANYANA (PROGRAM OPERATING OFFICER)
(623) 777-0427
Entity
Organization
Contact information
Practice address
9223 W MEADOW BROOK, 9223 W MEADOW BROOK AVE, PHOENIX, AZ 85037-8503
(207) 409-6515
Mailing address
9223 W MEADOWBROOK AVE, PHOENIX, AZ 85037-2442
(207) 409-6515
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
NO OTHER IDENTIFICATION NUMBER AVAILABLE
AZ
05
—
003
—
AZ
Enumeration date
03/10/2020
Last updated
03/10/2020
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