Provider Demographics
NPI:1225765951
Name:CALM INTEGRATED HEALTHCARE LLC
Entity Type:Organization
Organization Name:CALM INTEGRATED HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KABWAYI
Authorized Official - Middle Name:
Authorized Official - Last Name:KABONGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-434-0388
Mailing Address - Street 1:185 N APACHE TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-3970
Mailing Address - Country:US
Mailing Address - Phone:480-434-0388
Mailing Address - Fax:
Practice Address - Street 1:185 N APACHE TRL STE 1
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-3970
Practice Address - Country:US
Practice Address - Phone:480-434-0388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC11856OtherADHS-ARIZONA DEP OF HEALTH SERVICES