Provider Demographics
NPI:1922473255
Name:KEWALA CORPORATIONS
Entity Type:Organization
Organization Name:KEWALA CORPORATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEHINDE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-703-8083
Mailing Address - Street 1:10829 E VERBINA LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-7312
Mailing Address - Country:US
Mailing Address - Phone:623-703-8083
Mailing Address - Fax:520-447-7709
Practice Address - Street 1:10829 E VERBINA LN
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-7312
Practice Address - Country:US
Practice Address - Phone:623-703-8083
Practice Address - Fax:520-447-7709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-12
Last Update Date:2015-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4748320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness