Organization
DESTINY BEHAVIORAL HEALTH RESIDENTIAL CARE LLC 4
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FUNSO FEYI OGUNLA (PROGRAM DIRECTOR)
(602) 384-8820
Entity
Organization
Contact information
Practice address
2911 S 87TH DR, TOLLESON, AZ 85353-8650
(623) 435-6566
Mailing address
8809 W PRESTON LN, TOLLESON, AZ 85353-6995
(623) 399-9226
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4694
AZ
Other
Enumeration date
09/24/2015
Last updated
09/24/2015
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