Organization
DEVERUEX
Active
Other names
Adult Foster Care Provider
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE MICHELLE CHAMBERS (ADULT FOSTER CARE)
(480) 438-5338
Entity
Organization
Contact information
Practice address
22958 W GARDENIA DR, BUCKEYE, AZ 85326-6230
(480) 438-5338
Mailing address
22958 W GARDENIA DR, BUCKEYE, AZ 85326-6230
(480) 438-5338
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033425368
ACCCHS
AZ
Enumeration date
07/09/2016
Last updated
07/09/2016
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