Organization
PREMIUM RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KESIENA ERUOTOR (ADMINISTRATOR)
(346) 754-4511
Entity
Organization
Contact information
Practice address
3545 N CINNABAR PL, CASA GRANDE, AZ 85122
(346) 754-4511
Mailing address
3545 N CINNABAR PL, CASA GRANDE, AZ 85122
(346) 754-4511
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/01/2022
Last updated
08/26/2024
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