Organization
YOUNG RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATASHEANNE COCKHREN (SOLE MEMBER/ CEO)
(619) 647-7568
Entity
Organization
Contact information
Practice address
6449 S 16TH PL, PHOENIX, AZ 85042-4569
(619) 647-7568
Mailing address
2177 S MCQUEEN RD APT 3002, CHANDLER, AZ 85286-1849
(619) 647-7568
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/02/2021
Last updated
06/02/2021
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