Provider Demographics
NPI:1295323095
Name:ANGEL HEART BEHAVIORAL HEALTH V , LLC
Entity type:Organization
Organization Name:ANGEL HEART BEHAVIORAL HEALTH V , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NIBIZI
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:207-409-6515
Mailing Address - Street 1:3909 S 103RD DR
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-4187
Mailing Address - Country:US
Mailing Address - Phone:207-409-6515
Mailing Address - Fax:623-777-0082
Practice Address - Street 1:3909 S 103RD DR
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-4187
Practice Address - Country:US
Practice Address - Phone:207-409-6515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness