Provider Demographics
NPI:1386204220
Name:BENCHMARK VALLEY LLC
Entity Type:Organization
Organization Name:BENCHMARK VALLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TITUS
Authorized Official - Middle Name:KIMANI
Authorized Official - Last Name:MWANGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-386-6705
Mailing Address - Street 1:5625 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-5247
Mailing Address - Country:US
Mailing Address - Phone:858-386-6705
Mailing Address - Fax:602-368-4535
Practice Address - Street 1:3230 W JESSICA LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-4345
Practice Address - Country:US
Practice Address - Phone:858-386-6705
Practice Address - Fax:602-368-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities