Provider Demographics
NPI:1790427037
Name:GRACEVIEW BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:GRACEVIEW BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTHONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-206-8584
Mailing Address - Street 1:3909 W WOOD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1952
Mailing Address - Country:US
Mailing Address - Phone:480-206-8584
Mailing Address - Fax:602-680-3323
Practice Address - Street 1:9531 S 16TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5631
Practice Address - Country:US
Practice Address - Phone:480-206-8584
Practice Address - Fax:602-680-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities