Providence Behavioral Health LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

PROVIDENCE BEHAVIORAL HEALTH LLC

Practice address

8714 W Pioneer St
Tolleson, AZ 85353-8618

Phone

(602) 628-2266

NPI assigned

Apr 5, 2022

Organization subpart

No

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

Authorized official

Name

Funmilola Elizabeth-Tosin OgunlaNPI 1992561914

Title

Director

Phone

(602) 628-2266

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Funmilola Elizabeth-Tosin Ogunla

  • Student in an Organized Health Care Education/Training Program
  • Boston, MA
  • NPI 1992561914
  NPD Authorized official

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1700527637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8714 W PIONEER ST",
            "city": "TOLLESON",
            "state": "AZ",
            "postal_code": "853538618",
            "telephone_number": "602-628-2266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8714 W PIONEER ST",
            "city": "TOLLESON",
            "state": "AZ",
            "postal_code": "853538618",
            "telephone_number": "602-628-2266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "OGUNLA",
        "authorized_official_first_name": "FUNMILOLA",
        "authorized_official_middle_name": "ELIZABETH-TOSIN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "602-628-2266"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Tolleson, AZ
• Providers in Tolleson, AZ by specialty
• 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 Apr 5, 2022; 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.