Provider Demographics
NPI:1326665837
Name:SOL ACOMA BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:SOL ACOMA BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAVU
Authorized Official - Middle Name:
Authorized Official - Last Name:JARICHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-313-0827
Mailing Address - Street 1:10339 W MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-1262
Mailing Address - Country:US
Mailing Address - Phone:623-313-0827
Mailing Address - Fax:623-201-6004
Practice Address - Street 1:3437 W ACOMA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-5620
Practice Address - Country:US
Practice Address - Phone:602-942-0316
Practice Address - Fax:623-934-3408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health