Organization
HIS MERCY ASSISTED LLC
Active
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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