Provider Demographics
NPI:1639531072
Name:DOVE IN THE VALLEY LLC
Entity Type:Organization
Organization Name:DOVE IN THE VALLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:HORTENSE
Authorized Official - Last Name:TIOKOU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-616-3858
Mailing Address - Street 1:5450 W WHITTEN ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-7813
Mailing Address - Country:US
Mailing Address - Phone:480-616-3858
Mailing Address - Fax:
Practice Address - Street 1:6812 S 21ST DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6561
Practice Address - Country:US
Practice Address - Phone:602-268-6554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
AZBH4783324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health