Organization
CHARLES RESIDENTIAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EUGENIA ASOTA RN (DIRECTOR)
(309) 269-0798
Entity
Organization
Contact information
Practice address
15813 W MONROE ST, GOODYEAR, AZ 85338-6896
(623) 882-1294
Mailing address
15561 W DEVONSHIRE AVE, GOODYEAR, AZ 85395-7772
(623) 882-1294
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4681
AZ
324500000X
Substance Abuse Rehabilitation Facility
BH4681
AZ
Other
Enumeration date
10/20/2015
Last updated
10/20/2015
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