Provider Demographics
NPI:1790440915
Name:MY CITY RADIUS COMMUNITY HEALTH SERVICES
Entity Type:Organization
Organization Name:MY CITY RADIUS COMMUNITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FAVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIKELU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-651-6458
Mailing Address - Street 1:46160 W AMSTERDAM RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-6957
Mailing Address - Country:US
Mailing Address - Phone:480-651-6458
Mailing Address - Fax:
Practice Address - Street 1:46160 W AMSTERDAM RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-6957
Practice Address - Country:US
Practice Address - Phone:480-651-6458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness