Provider Demographics
NPI:1912574989
Name:CARES OF ZION BEHAVIOR GROUP HOME
Entity Type:Organization
Organization Name:CARES OF ZION BEHAVIOR GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:TEBOH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:216-544-5418
Mailing Address - Street 1:3045 E CHOLLA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1917
Mailing Address - Country:US
Mailing Address - Phone:602-601-4893
Mailing Address - Fax:
Practice Address - Street 1:3045 E CHOLLA ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1917
Practice Address - Country:US
Practice Address - Phone:602-601-4893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADORA HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ024418Medicaid