Provider Demographics
NPI:1356187942
Name:KEDUNA BEHAVIORAL HEALTHCARE LLC
Entity type:Organization
Organization Name:KEDUNA BEHAVIORAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UKO
Authorized Official - Middle Name:
Authorized Official - Last Name:UDOFIA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:480-330-2767
Mailing Address - Street 1:1925 E EVERETT DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3939
Mailing Address - Country:US
Mailing Address - Phone:480-330-2767
Mailing Address - Fax:
Practice Address - Street 1:23911 N 25TH WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-5237
Practice Address - Country:US
Practice Address - Phone:480-908-5268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy