Organization
MOSES BEHAVIORAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE AGBOOLA (ADMINISTRATOR)
(480) 589-6692
Entity
Organization
Contact information
Practice address
17622 W PORT ROYALE LN, SURPRISE, AZ 85388-7792
(480) 286-3366
Mailing address
17622 W PORT ROYALE LN, SURPRISE, AZ 85388-7792
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
BH4520
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
918102
—
AZ
Enumeration date
12/15/2014
Last updated
03/05/2024
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