Organization
STARLIGHT BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANICET NDAGIJIMANA (OWNER)
(520) 445-5832
Entity
Organization
Contact information
Practice address
5668 N 109TH AVE, PHOENIX, AZ 85037-5768
(520) 445-5832
Mailing address
5668 N 109TH AVE, PHOENIX, AZ 85037-5768
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH7579
AZDHS
AZ
Enumeration date
06/01/2022
Last updated
06/01/2022
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