Organization
SKA-SHIFRA FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOB KABAMBA (OWNER/ CEO)
(203) 545-0242
Entity
Organization
Contact information
Practice address
7136 N 73RD DR, GLENDALE, AZ 85303-2569
(203) 545-0242
Mailing address
7136 N 73RD DR, GLENDALE, AZ 85303-2569
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4983
AZ
Other
Enumeration date
03/07/2017
Last updated
03/07/2017
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