| Success Behavioral Group Home Llc | |
|
8733 W Cordes Rd Tolleson AZ 85353-8606 | |
| (602) 558-5847 | |
| (602) 671-6752 |
| Full Name | Success Behavioral Group Home Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 8733 W Cordes Rd, Tolleson, Arizona |
| Authorized Official Name and Position | Emmanuel Israel Omasere (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6025585847 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Success Behavioral Group Home Llc 8733 W Cordes Rd Tolleson AZ 85353-8606 Ph: (602) 558-5847 | Success Behavioral Group Home Llc 8733 W Cordes Rd Tolleson AZ 85353-8606 Ph: (602) 558-5847 |
| NPI Number | 1942967989 |
|---|---|
| Provider Enumeration Date | 11/24/2021 |
| Last Update Date | 11/24/2021 |
| Certification Date | 11/24/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942967989 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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