| Heavenly Behavioral Home Llc | |
|
4209 W Irwin Ave Phoenix AZ 85041-6089 | |
| (623) 235-7871 | |
| Not Available |
| Full Name | Heavenly Behavioral Home Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 4209 W Irwin Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Maria Celia Dela Cruz (OWNER) |
| Authorized Official Contact | 6232357871 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Heavenly Behavioral Home Llc 4209 W Irwin Ave Phoenix AZ 85041-6089 Ph: (623) 235-7871 | Heavenly Behavioral Home Llc 4209 W Irwin Ave Phoenix AZ 85041-6089 Ph: (623) 235-7871 |
| NPI Number | 1255960043 |
|---|---|
| Provider Enumeration Date | 04/03/2020 |
| Last Update Date | 09/28/2020 |
| Certification Date | 09/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255960043 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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