Provider Demographics
NPI:1013634732
Name:DITABELL BEHAVIORAL HEALTH CARE LLC
Entity Type:Organization
Organization Name:DITABELL BEHAVIORAL HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:MBENDA
Authorized Official - Last Name:DISSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-453-8343
Mailing Address - Street 1:7821 S 46TH LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2381
Mailing Address - Country:US
Mailing Address - Phone:480-453-8343
Mailing Address - Fax:
Practice Address - Street 1:3441 S 77TH LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-1258
Practice Address - Country:US
Practice Address - Phone:480-453-8343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility