Organization
PROVIDENCE HEALTH LLC
Active
Organization
PROVIDENCE HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORY EZENWAKA (CEO/OWNER)
(480) 434-1113
Entity
Organization
Contact information
Practice address
6311 W MAGDALENA LN, LAVEEN, AZ 85339-5483
(480) 434-1113
Mailing address
6311 W MAGDALENA LN, LAVEEN, AZ 85339-5483
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
12/18/2023
Last updated
12/18/2023
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