Organization
LOLOMA HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA HORNBACK (OWNER/ADMINISTRATIVE OFFICER)
(623) 418-6657
Entity
Organization
Contact information
Practice address
15259 N 67TH DR, PEORIA, AZ 85381-4502
(623) 418-6657
(623) 322-8664
Mailing address
15259 N 67TH DR, PEORIA, AZ 85381-4502
(623) 418-6657
(623) 322-8664
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4687
AZ
Other
Enumeration date
11/29/2016
Last updated
11/30/2016
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