# MARY GROUP HOME LLC

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

## Provider details

- **NPI number:** 1760342083
- **Authorized official:** ABDALLA ELKHALIFA (CEO)
- **Authorized official phone:** (480) 577-7777

## Contact information

- **Practice address:** 12643 N 22ND AVE, PHOENIX, AZ 85029-2652
- **Practice address phone:** (480) 577-7777
- **Mailing address:** 12643 N 22ND AVE, PHOENIX, AZ 85029-2652
- **Mailing address phone:** (480) 577-7777

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 11/18/2025
- **Last updated:** 11/18/2025