Provider Demographics
NPI:1033414222
Name:RIVER OF LIFE BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:RIVER OF LIFE BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TUNUFAI
Authorized Official - Middle Name:FASI
Authorized Official - Last Name:TAASE
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:480-776-3392
Mailing Address - Street 1:1237 S VAL VISTA DR
Mailing Address - Street 2:214
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6401
Mailing Address - Country:US
Mailing Address - Phone:480-776-3392
Mailing Address - Fax:480-396-0532
Practice Address - Street 1:1237 S VAL VISTA DR
Practice Address - Street 2:214
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6401
Practice Address - Country:US
Practice Address - Phone:480-776-3392
Practice Address - Fax:480-396-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3707251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health