Organization
MARY GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABDALLA ELKHALIFA (CEO/OWNER)
(623) 565-3922
Entity
Organization
Contact information
Practice address
15111 N 33RD PL, PHOENIX, AZ 85032-4552
(623) 565-3922
Mailing address
2084 E WASHINGTON AVE, GILBERT, AZ 85234-6229
(623) 565-3922
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH5112
AZ
Other
Enumeration date
05/02/2017
Last updated
06/03/2025
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