| Khadjenoury Llc | |
|
Hc 61, Box D Edventures Program C/o Leupp Schools Inc Leupp AZ 86047 | |
| (520) 907-6890 | |
| (801) 944-2940 |
| Full Name | Khadjenoury Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | Hc 61, Box D, Leupp, Arizona |
| Authorized Official Name and Position | Siamak Khadjenoury (CEO) |
| Authorized Official Contact | 5209076890 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Khadjenoury Llc 8848 Willow Hills Ct Sandy UT 84093-1889 Ph: (520) 907-6890 | Khadjenoury Llc Hc 61, Box D Edventures Program C/o Leupp Schools Inc Leupp AZ 86047 Ph: (520) 907-6890 |
| NPI Number | 1316198302 |
|---|---|
| Provider Enumeration Date | 10/08/2008 |
| Last Update Date | 10/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316198302 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Winslow Indian Health Care Center, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1.5 N Of Leupp Chapter House, Leupp, AZ 86035 Phone: 928-289-4646 Fax: 928-289-6290 |