Organization
AZ COMFORT HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN OMIJIE (PROGRAM DIRECTOR)
(623) 326-3327
Entity
Organization
Contact information
Practice address
23832 W TONTO STREET, BUCKEYE, AZ 85326
(623) 666-3895
(623) 321-1206
Mailing address
23832 W TONTO ST, BUCKEYE, AZ 85326-8139
(623) 666-3895
(623) 321-1206
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
BH5219
AZ
Other
Enumeration date
08/08/2017
Last updated
07/21/2022
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