Organization
HEALVINE LLC
Active
Organization
HEALVINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMED OTHMAN (OWNER)
(602) 815-3293
Entity
Organization
Contact information
Practice address
1204 E BASELINE RD STE 106, TEMPE, AZ 85283-1447
(877) 755-8040
Mailing address
1204 E BASELINE RD STE 106, TEMPE, AZ 85283-1447
(877) 755-8040
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
08/31/2021
Last updated
08/16/2022
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