Provider Demographics
NPI:1972119733
Name:ACOMA BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:ACOMA BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RWABUNEZA VIOLET
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-449-4140
Mailing Address - Street 1:3437 W ACOMA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-5620
Mailing Address - Country:US
Mailing Address - Phone:602-888-6779
Mailing Address - Fax:
Practice Address - Street 1:3437 W ACOMA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-5620
Practice Address - Country:US
Practice Address - Phone:602-888-6779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251B00000XAgenciesCase Management
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility