Organization
M & M RESIDENTIAL HOME LLC
Active
Organization
M & M RESIDENTIAL HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAVIS PANFORD (PROGRAM DIRECTOR)
(573) 855-1210
Entity
Organization
Contact information
Practice address
8572 W PALO VERDE AVE, PEORIA, AZ 85345-5354
(623) 249-3105
(623) 249-3105
Mailing address
8572 W PALO VERDE AVE, PEORIA, AZ 85345-5354
(623) 249-3105
(623) 249-3105
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH5412
AZ
Other
Enumeration date
04/12/2018
Last updated
04/12/2018
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