Provider Demographics
NPI:1306442678
Name:ONWUCHEKWA, KELECHI
Entity type:Individual
Prefix:
First Name:KELECHI
Middle Name:
Last Name:ONWUCHEKWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12228 W PIMA ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-8105
Mailing Address - Country:US
Mailing Address - Phone:602-472-0105
Mailing Address - Fax:
Practice Address - Street 1:9005 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3637
Practice Address - Country:US
Practice Address - Phone:602-472-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility