Provider Demographics
NPI:1134850050
Name:WERISE BEHAVIORAL HOME LLC
Entity type:Organization
Organization Name:WERISE BEHAVIORAL HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:MOHAMUD
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-324-6692
Mailing Address - Street 1:1652 N 52ND ST APT 13
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-3419
Mailing Address - Country:US
Mailing Address - Phone:480-324-6692
Mailing Address - Fax:
Practice Address - Street 1:10514 W HILTON AVE
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-5615
Practice Address - Country:US
Practice Address - Phone:612-987-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable