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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