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Organization

SUCCESS BEHAVIORAL GROUP HOME LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
EMMANUEL ISRAEL OMASERE (CHIEF EXECUTIVE OFFICER)
(602) 558-5847
Entity
Organization

Contact information

Practice address
8733 W CORDES RD, TOLLESON, AZ 85353-8606
(602) 558-5847
(602) 671-6752
Mailing address
8733 W CORDES RD, TOLLESON, AZ 85353-8606
(602) 558-5847
(602) 671-6752

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
11/24/2021
Last updated
11/24/2021
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