Organization
GRACE HOUSE BEHAVIORAL HEALTH AGENCY LEVEL 3
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAUL WASSWA (OWNER/ADMINISTRATOR)
(623) 583-8086
Entity
Organization
Contact information
Practice address
2733 W MICHIGAN AVE, PHOENIX, AZ 85053-1734
(623) 583-8086
Mailing address
2733 W MICHIGAN AVE, PHOENIX, AZ 85053-1734
(623) 583-8086
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH-3475
AZ
Other
Enumeration date
01/08/2010
Last updated
01/08/2010
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