Individual
EDMOND NYAGATARE MANZI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LUX SPEI HOMES, LLC
Contact information
Practice address
2906 W HUNTINGTON DR, PHOENIX, AZ 85041-4450
(602) 394-5954
Mailing address
2906 W HUNTINGTON DR, PHOENIX, AZ 85041-4450
(602) 394-5954
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH8008
AZ
Other
Enumeration date
05/22/2023
Last updated
09/04/2023
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