# SAN JUDAS GROUP HOME

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

## Provider details

- **NPI number:** 1386969947
- **Authorized official:** IMELDA MELISSA NORIEGA (ADMINISTRATOR)
- **Authorized official phone:** (602) 643-5932

## Contact information

- **Practice address:** 5116 S 11TH AVE, PHOENIX, AZ 85041-2363
- **Practice address phone:** (602) 643-5932
- **Practice address fax:** (602) 281-6974
- **Mailing address:** 5415 S 5TH AVE, PHOENIX, AZ 85041-4000
- **Mailing address phone:** (602) 643-5932
- **Mailing address fax:** (602) 281-6974

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | ALH6076 | AZ | Yes |

## Other

- **Enumeration date:** 04/07/2010
- **Last updated:** 04/07/2010