Provider Demographics
NPI:1801420476
Name:HOLY TRINITY BEHAVIORAL,LLC
Entity Type:Organization
Organization Name:HOLY TRINITY BEHAVIORAL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMBOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-271-9011
Mailing Address - Street 1:1630 W NANCY LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-5540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1630 W NANCY LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5540
Practice Address - Country:US
Practice Address - Phone:623-271-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY TRINITY BEHAVIORAL,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances