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Organization

LIGHT CENTER BEHAVIORAL HEALTH LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANNE MARIE NTIRANYIBAGIRA (PARTNER)
(520) 445-5832
Entity
Organization

Contact information

Practice address
6619 N 19TH AVE # C1, PHOENIX, AZ 85015-1631
(520) 445-5832
Mailing address
6619 N 19TH AVE # C1, PHOENIX, AZ 85015-1631
(520) 445-5832

Taxonomy

Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
261QM1300X
Multi-Specialty Clinic/Center
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
BH8241
AZ
Enumeration date
12/14/2022
Last updated
12/14/2022
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