Loloma House LLC

NPI #1063886075 in Peoria, Arizona

Provider Information

NPI Number: 1063886075
Entity Type: Organization
Organization Name: Loloma House LLC
Primary Specialty: Community Based Residential Treatment Facility, Mental Illness
Enumeration Date: Nov 16, 2015
Last Updated: Nov 16, 2015

Practice Location

Address: 7402 W SHANGRI LA RD
City: Peoria
State: Arizona
ZIP Code: 85345-5812
Phone: (623) 418-6657

Authorized Official

Name: LAURA HORNBACK
Title: OWNER/ADMINISTRATIVE OFFICER
Phone: (623) 418-6657

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Mental Illness	320800000X	Primary

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