Provider Demographics
NPI:1770036022
Name:SILKWORTH MANOR LLC
Entity type:Organization
Organization Name:SILKWORTH MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-684-0503
Mailing Address - Street 1:10575 N 114TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254
Mailing Address - Country:US
Mailing Address - Phone:602-684-0503
Mailing Address - Fax:480-393-3866
Practice Address - Street 1:10575 N 114TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:602-684-0503
Practice Address - Fax:480-393-3866
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SILKWORTH MANOR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility