Merciful Behavioral Health Services LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

BH4775 Issued in AZ

Legal business name

MERCIFUL BEHAVIORAL HEALTH SERVICES LLC

Practice address

12383 W Glenrosa Ave
Avondale, AZ 85392-4287

Phone

(602) 516-4992

NPI assigned

Jan 15, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Okunlola O Betiku

Title

Program Director

Phone

(602) 516-4992

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1477910883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12383 W GLENROSA AVE",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853924287",
            "telephone_number": "602-516-4992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12383 W GLENROSA AVE",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853924287",
            "telephone_number": "602-516-4992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCIFUL BEHAVIORAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-15",
        "last_updated": "2016-01-15",
        "status": "A",
        "authorized_official_last_name": "BETIKU",
        "authorized_official_first_name": "OKUNLOLA",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "602-516-4992"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH4775",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEHAVIORAL HEALTH",
            "identifier": "BH4775",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Avondale, AZ
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.