# COUNTRY CARE RESIDENTIAL SERVICES LLC

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

## Provider details

- **NPI number:** 1285320812
- **Authorized official:** MR. JUDITH OYUO (ADMINISTRATOR)
- **Authorized official phone:** (623) 600-8863

## Contact information

- **Practice address:** 3241 S 93RD DR, TOLLESON, AZ 85353-5536
- **Practice address phone:** (623) 600-8863
- **Mailing address:** 3241 S 93RD DR, TOLLESON, AZ 85353-5536
- **Mailing address phone:** (623) 600-8863

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | — | NULL | — |

## Other

- **Enumeration date:** 04/17/2023
- **Last updated:** 04/17/2023