Organization
HUDUMA HOUSE, LLC
Active
Organization
HUDUMA HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT K KOSKEI (HEALTHCARE MANAGER)
(602) 516-9785
Entity
Organization
Contact information
Practice address
6221 W ILLINI ST, PHOENIX, AZ 85043-1915
(602) 516-9785
Mailing address
6221 W ILLINI ST, PHOENIX, AZ 85043-1915
(602) 516-9785
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
01
—
BH5656
ARIZONA DEPARTMENT OF HEALTH SERVICES
AZ
Enumeration date
03/05/2019
Last updated
03/05/2019
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