# JCA AFC HOMES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154916245
- **Authorized official:** DOMINIQUE GIST (OWNER)
- **Authorized official phone:** (313) 434-6821

## Contact information

- **Practice address:** 8674 S 165TH AVE, GOODYEAR, AZ 85338-1447
- **Practice address phone:** (602) 731-1883
- **Mailing address:** 11213 W IVORY LN, AVONDALE, AZ 85392-3916

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/01/2021
- **Last updated:** 03/01/2021