Organization
MERCIFUL BEHAVIORAL HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OKUNLOLA O BETIKU (PROGRAM DIRECTOR)
(602) 516-4992
Entity
Organization
Contact information
Practice address
12383 W GLENROSA AVE, AVONDALE, AZ 85392-4287
(602) 516-4992
Mailing address
12383 W GLENROSA AVE, AVONDALE, AZ 85392-4287
(602) 516-4992
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4775
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH4775
BEHAVIORAL HEALTH
AZ
Enumeration date
01/15/2016
Last updated
01/15/2016
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