Organization
TOLLESON HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IFFA DIRIBA WOLKABA SOCIAL WORKER (OWNER)
(602) 330-2203
Entity
Organization
Contact information
Practice address
10314 W SUPERIOR AVE, TOLLESON, AZ 85353-8423
(602) 330-2203
Mailing address
10314 W SUPERIOR AVE, TOLLESON, AZ 85353-8423
(602) 330-2203
(623) 792-7488
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
AL9017H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D00778622
SOCIAL WORK
AZ
Enumeration date
07/02/2014
Last updated
07/02/2014
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