Organization
KAZE BEHAVIORAL HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA KANEZA (ADMINISTRATOR)
(520) 270-0622
Entity
Organization
Contact information
Practice address
9126 W VERNON AVE, PHOENIX, AZ 85037-4242
(520) 270-0622
Mailing address
9126 W VERNON AVE, PHOENIX, AZ 85037-4242
(520) 270-0622
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
—
BH8021
AZDHS
AZ
Enumeration date
11/03/2022
Last updated
11/03/2022
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