Organization
BENCHMARK VALLEY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TITUS KIMANI MWANGI (ADMINISTRATOR)
(858) 386-6705
Entity
Organization
Contact information
Practice address
6928 W CARSON RD, LAVEEN, AZ 85339-7028
(858) 386-6705
(602) 603-3981
Mailing address
5625 W EUCLID AVE, LAVEEN, AZ 85339-5247
(858) 386-6705
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BH5679
—
AZ
Enumeration date
02/22/2019
Last updated
09/02/2020
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