Provider Demographics
NPI:1679347462
Name:GREAT VALLEY BEHAVIORAL HOMES
Entity type:Organization
Organization Name:GREAT VALLEY BEHAVIORAL HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHOLLETA
Authorized Official - Middle Name:WANJIRU
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:602-225-2201
Practice Address - Street 1:3255 W CARTER RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6227
Practice Address - Country:US
Practice Address - Phone:480-232-8260
Practice Address - Fax:602-225-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty