Provider Demographics
NPI:1164176145
Name:KAZE BEHAVIORAL HOME LLC
Entity Type:Organization
Organization Name:KAZE BEHAVIORAL HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-270-0622
Mailing Address - Street 1:2323 N 92ND LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4212
Mailing Address - Country:US
Mailing Address - Phone:520-270-0622
Mailing Address - Fax:
Practice Address - Street 1:2323 N 92ND LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4212
Practice Address - Country:US
Practice Address - Phone:520-270-0622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH7316OtherAZDHS