Organization
BENCHMARK VALLEY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TITUS KIMANI MWANGI (ADMINISTRATOR)
(858) 386-6705
Entity
Organization
Contact information
Practice address
7209 W FOREST GROVE AVE, PHOENIX, AZ 85043-7303
(858) 386-6705
Mailing address
5625 W EUCLID AVE, LAVEEN, AZ 85339-5247
(858) 386-6705
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BH5998
—
AZ
Enumeration date
06/24/2020
Last updated
07/02/2020
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