Organization
SUCCESSFUL LIVINGS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARRELL LEMONT ELLIS JR. (ADMINISTRATOR)
(480) 560-8924
Entity
Organization
Contact information
Practice address
304 N LINCOLN AVE, CASA GRANDE, AZ 85122-4634
(480) 560-8924
(520) 350-1790
Mailing address
304 N LINCOLN AVE, CASA GRANDE, AZ 85122-4634
(480) 560-8924
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH-4483
AZ
Other
Enumeration date
10/07/2014
Last updated
10/07/2014
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