Organization
FAITH BEHAVIORAL HEALTH GROUP, LLC
Active
Organization
FAITH BEHAVIORAL HEALTH GROUP, LLC
Active
Other names
FAITH BEHAVIORAL HEALTH GROUP LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARY KIILU (REGISTERED NURSE)
(909) 441-9520
Entity
Organization
Contact information
Practice address
3101 W LARKSPUR DR, PHOENIX, AZ 85029-2331
(602) 368-7178
Mailing address
3101 W LARKSPUR DR, PHOENIX, AZ 85029-2331
(602) 368-7178
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH5359
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH5359
ARIZONA STATE LICENSE
AZ
Enumeration date
02/06/2018
Last updated
12/30/2020
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