| Ezra Group Home Llc | |
|
6818 S 44th Ave Laveen AZ 85339-6252 | |
| (602) 315-2058 | |
| Not Available |
| Full Name | Ezra Group Home Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6818 S 44th Ave, Laveen, Arizona |
| Authorized Official Name and Position | Zenebech Girma (ADMINISTRATOR) |
| Authorized Official Contact | 6023152058 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ezra Group Home Llc 6818 S 44th Ave Laveen AZ 85339-6252 Ph: (602) 315-2058 | Ezra Group Home Llc 6818 S 44th Ave Laveen AZ 85339-6252 Ph: (602) 315-2058 |
| NPI Number | 1205584695 |
|---|---|
| Provider Enumeration Date | 03/14/2022 |
| Last Update Date | 03/14/2022 |
| Certification Date | 03/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205584695 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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