Provider Demographics
NPI:1346868049
Name:VALLEY WIDE BEHAVIORAL CARE, LLC
Entity Type:Organization
Organization Name:VALLEY WIDE BEHAVIORAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-823-8848
Mailing Address - Street 1:1089 S AMBER ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1415
Mailing Address - Country:US
Mailing Address - Phone:480-823-8848
Mailing Address - Fax:480-422-9187
Practice Address - Street 1:5217 W BEAUTIFUL LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2199
Practice Address - Country:US
Practice Address - Phone:480-823-8848
Practice Address - Fax:480-422-9187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health