Provider Demographics
NPI:1427745090
Name:GREAT VALLEY BEHAVIORAL HOMES
Entity type:Organization
Organization Name:GREAT VALLEY BEHAVIORAL HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHOLLETA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENJA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:480-232-8260
Mailing Address - Street 1:3255 W CARTER RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6227
Mailing Address - Country:US
Mailing Address - Phone:480-232-8260
Mailing Address - Fax:
Practice Address - Street 1:6338 W LATONA RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-3077
Practice Address - Country:US
Practice Address - Phone:480-232-8260
Practice Address - Fax:602-254-8004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREAT VALLEY BEHAVIORAL HOMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-24
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility