Organization
PROVIDENCE BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FUNMILOLA ELIZABETH-TOSIN OGUNLA (DIRECTOR)
(602) 628-2266
Entity
Organization
Contact information
Practice address
8714 W PIONEER ST, TOLLESON, AZ 85353-8618
(602) 628-2266
Mailing address
8714 W PIONEER ST, TOLLESON, AZ 85353-8618
(602) 628-2266
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/05/2022
Last updated
04/05/2022
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