Organization
BALM OF GILEAD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUSTIN EZENWA (ORGANIZER)
(949) 690-2305
Entity
Organization
Contact information
Practice address
15106 W SELLS DR, GOODYEAR, AZ 85395-7702
(480) 746-9776
Mailing address
15106 W SELLS DR, GOODYEAR, AZ 85395-7702
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/07/2022
Last updated
09/07/2022
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