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Organization
FAIRLANE GROUP HOME LLC
Active
Organization
FAIRLANE GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GABRIELLA FOSTER MAC, CHT (DIRECTOR OF OPERATIONS)
(602) 421-4663
Entity
Organization
Contact information
Practice address
821 W FAIRLANE CT, CASA GRANDE, AZ 85122-6688
(602) 421-4663
(602) 610-5557
Mailing address
16994 W RIO VISTA LN, GOODYEAR, AZ 85338-7409
(602) 421-4663
(602) 610-5557
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
04/11/2022
Last updated
04/12/2022
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