Provider Demographics
NPI:1619634458
Name:SPLENDOR BEHAVIORAL RESIDENCY LLC
Entity Type:Organization
Organization Name:SPLENDOR BEHAVIORAL RESIDENCY LLC
Other - Org Name:SPLENDOR BEHAVIORAL RESIDENCY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASARACHI
Authorized Official - Middle Name:DARLYN
Authorized Official - Last Name:EMEDORO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:713-291-1836
Mailing Address - Street 1:43842 W ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-5673
Mailing Address - Country:US
Mailing Address - Phone:713-291-1836
Mailing Address - Fax:
Practice Address - Street 1:43842 W ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-5673
Practice Address - Country:US
Practice Address - Phone:713-291-1836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility