| Loloma House At Greenway | |
|
6125 W Sunnyside Dr Glendale AZ 85304-2533 | |
| (623) 418-6657 | |
| Not Available |
| Full Name | Loloma House At Greenway |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6125 W Sunnyside Dr, Glendale, Arizona |
| Authorized Official Name and Position | Laura Adiloba Hornback (OWNER / ADMINISTRATOR) |
| Authorized Official Contact | 6234186657 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Loloma House At Greenway 8408 W Willow Ave Peoria AZ 85381-4864 Ph: (623) 418-6657 | Loloma House At Greenway 6125 W Sunnyside Dr Glendale AZ 85304-2533 Ph: (623) 418-6657 |
| NPI Number | 1407482268 |
|---|---|
| Provider Enumeration Date | 03/12/2020 |
| Last Update Date | 03/27/2020 |
| Certification Date | 03/27/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407482268 | NPI | - | NPPES |
| 1942743711 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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