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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