Organization
MOSES BEHAVIORAL CARE
Active
Parent organization
MOSES ASSISTED LIVING
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOSES ASSISTED LIVING
Authorized official
ELIZABETH AGBOOLA (ADMINISTRATOR)
(480) 589-6692
Entity
Organization
Contact information
Practice address
17622 W PORT ROYALE LN, SURPRISE, AZ 85379
(480) 286-3366
Mailing address
17622 W PORT ROYALE LN, SURPRISE, AZ 85388-7792
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4520
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
986532
—
AZ
Enumeration date
03/27/2015
Last updated
07/10/2023
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