Organization
JCA AFC HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE GIST (OWNER)
(313) 434-6821
Entity
Organization
Contact information
Practice address
8674 S 165TH AVE, GOODYEAR, AZ 85338-1447
(602) 731-1883
Mailing address
11213 W IVORY LN, AVONDALE, AZ 85392-3916
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/01/2021
Last updated
03/01/2021
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