Organization
TASSILIMAN HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMED KALLE (ADMINISTRATOR)
(602) 884-3162
Entity
Organization
Contact information
Practice address
7419 W DARROW ST, LAVEEN, AZ 85339-2644
(623) 248-9448
Mailing address
502 N 112TH DR, AVONDALE, AZ 85323-7902
(623) 248-9448
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/14/2024
Last updated
12/17/2024
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