Organization
IRMA BEHAVIORAL HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH NGUNDU (ADMINISTRATOR)
(503) 964-0794
Entity
Organization
Contact information
Practice address
7034 W IRMA LN, GLENDALE, AZ 85308-9459
(623) 215-3652
Mailing address
7034 W IRMA LN, GLENDALE, AZ 85308-9459
(623) 215-3652
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
07/10/2020
Last updated
07/10/2020
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