Organization
ZKALA IC - MYRTLE
Active
Parent organization
Z'KALA, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
Z'KALA, LLC
Authorized official
JAVAN LEE (EXECUTIVE LEADERSHIP)
(623) 777-8339
Entity
Organization
Contact information
Practice address
7112 N 55TH AVE STE C, GLENDALE, AZ 85301-0707
(602) 842-9000
Mailing address
8050 N 19TH AVE STE 500, PHOENIX, AZ 85021-5160
(623) 842-9000
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QD0000X
Dental Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
09/27/2022
Last updated
09/27/2022
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