Organization
HIS MERCY ASSISTED LLC
Active
Other names
His Mercy Assisted LLC
Organization subpart
No
Provider details
NPI number
Authorized official
AYO AGORO CEO (OWNER)
(623) 600-8926
Entity
Organization
Contact information
Practice address
12362 W JOBLANCA RD, AVONDALE, AZ 85323-3130
(623) 600-8926
Mailing address
12362 W JOBLANCA RD, AVONDALE, AZ 85323-3130
(623) 600-8926
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH6411
STATE
AZ
Enumeration date
01/04/2021
Last updated
01/04/2021
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