Organization
MOSES BEHAVIORAL CARE
Active
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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