| Arizona Shalom Center, Llc | |
|
22453 N Vanderveen Way Maricopa AZ 85138-5570 | |
| (480) 358-7189 | |
| Not Available |
| Full Name | Arizona Shalom Center, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 22453 N Vanderveen Way, Maricopa, Arizona |
| Authorized Official Name and Position | Etienne Ahayo (ADMINSTRATOR) |
| Authorized Official Contact | 4803587189 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Arizona Shalom Center, Llc 22453 N Vanderveen Way Maricopa AZ 85138-5570 Ph: (480) 358-7189 | Arizona Shalom Center, Llc 22453 N Vanderveen Way Maricopa AZ 85138-5570 Ph: (480) 358-7189 |
| NPI Number | 1245819911 |
|---|---|
| Provider Enumeration Date | 04/07/2021 |
| Last Update Date | 04/07/2021 |
| Certification Date | 04/07/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245819911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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