Provider Demographics
NPI:1770174294
Name:BEMOR LLC
Entity type:Organization
Organization Name:BEMOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:DAMON
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:480-243-6078
Mailing Address - Street 1:1725 W EVA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2963
Mailing Address - Country:US
Mailing Address - Phone:480-243-6078
Mailing Address - Fax:
Practice Address - Street 1:1725 W EVA ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2963
Practice Address - Country:US
Practice Address - Phone:480-243-6078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health