Organization
WILSHIRE HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANIS NTOUKAM (MANAGER)
(602) 802-4209
Entity
Organization
Contact information
Practice address
8809 W WILSHIRE DR, PHOENIX, AZ 85037-3641
(602) 802-4209
Mailing address
8809 W WILSHIRE DR, PHOENIX, AZ 85037-3641
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
07/30/2021
Last updated
04/14/2022
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