Provider Demographics
NPI:1598272825
Name:MOSES ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:MOSES ASSISTED LIVING LLC
Other - Org Name:MOSES BEHAVIORAL CARE III
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-589-6692
Mailing Address - Street 1:829 E CHIPMAN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040
Mailing Address - Country:US
Mailing Address - Phone:602-603-9474
Mailing Address - Fax:
Practice Address - Street 1:829 E CHIPMAN RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8504
Practice Address - Country:US
Practice Address - Phone:602-603-9474
Practice Address - Fax:602-603-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness