Organization
WAGONER CARE LLC
Active
Organization
WAGONER CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER HUGHES (OWNER)
(623) 776-9189
Entity
Organization
Contact information
Practice address
6127 W WAGONER RD, GLENDALE, AZ 85308-1150
(602) 334-1788
Mailing address
8465 W GRAND AVE, PEORIA, AZ 85345-8102
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/01/2019
Last updated
06/11/2019
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