Organization
DESTINY BEHAVIORAL HEALTH RESIDENTIAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FUNSO FEYI OGUNLA (PROGRAM DIRECTOR)
(623) 435-6566
Entity
Organization
Contact information
Practice address
2911 S 87TH DR, TOLLESON, AZ 85353-8650
(623) 435-6566
(623) 435-6566
Mailing address
2911 S 87TH DR, TOLLESON, AZ 85353-8650
(623) 435-6566
(623) 435-6566
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4023
AZ
Other
Enumeration date
04/10/2012
Last updated
04/10/2012
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