HIS MERCY ASSISTED LLC NPI 1366030561

NPI Information

NPI: 1366030561
Provider Name: HIS MERCY ASSISTED LLC
Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
Address:
12362 W JOBLANCA RD
AVONDALE, AZ
ZIP 85323
Phone: (623) 600-8926
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HIS MERCY ASSISTED LLC is a community based residential treatment facility mental illness in Avondale, AZ. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. HIS MERCY ASSISTED LLC NPI is 1366030561. The provider is registered as an organization entity type.

The provider's business location address is:

12362 W JOBLANCA RD
AVONDALE, AZ
ZIP 85323-130
Phone: (623) 600-8926

The provider's authorized official is Ayo Agoro .
The authorized official title is Owner and has the following contact phone number (623) 600-8926.

The enumeration date for this NPI number is 1/4/2021 and was last updated on 1/4/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320800000X	Community Based Residential Treatment Facility, Mental Illness				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	BH6411	OTHER	ARIZONA	STATE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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