Provider Demographics
NPI:1508617051
Name:ASHU LINEAGE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ASHU LINEAGE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ETU
Authorized Official - Last Name:MUKOKO
Authorized Official - Suffix:
Authorized Official - Credentials:DCW
Authorized Official - Phone:480-409-8245
Mailing Address - Street 1:9423 W VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4316
Mailing Address - Country:US
Mailing Address - Phone:480-409-8245
Mailing Address - Fax:
Practice Address - Street 1:9423 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4316
Practice Address - Country:US
Practice Address - Phone:480-409-8245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251E00000XAgenciesHome Health