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Organization

WEALTH REFUGE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ILDEPHONSE FAYIDA RN, MS, MA (DIRECTOR)
(802) 579-8027
Entity
Organization

Contact information

Practice address
7734 S 47TH LN, LAVEEN, AZ 85339-2388
(802) 579-8027
Mailing address
7734 S 47TH LN, LAVEEN, AZ 85339-2388
(802) 579-8027

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
261QM0850X
Adult Mental Health Clinic/Center
Primary

Other

Enumeration date
04/21/2023
Last updated
04/25/2023
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