Organization
AZ LAVENDER BEHAVIORAL HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ZUHAL FADL (ADMINISTRATOR)
(602) 581-1588
Entity
Organization
Contact information
Practice address
3428 N 47TH AVE, PHOENIX, AZ 85031-3101
(602) 581-1588
(623) 302-7174
Mailing address
3428 N 47TH AVE, PHOENIX, AZ 85031-3101
(602) 581-1588
(623) 302-7174
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH7476
DHS
AZ
Enumeration date
05/09/2022
Last updated
05/09/2022
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