Organization
DIVINE GRACE RESIDENTIAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SABESTINE ONYEPUNUKA (ASSISTANT ADMINISTRATOR)
(623) 512-1675
Entity
Organization
Contact information
Practice address
4120 N 105TH LN, PHOENIX, AZ 85037-5843
(623) 272-0428
Mailing address
930 E DEE ST, AVONDALE, AZ 85323-2777
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/01/2023
Last updated
02/01/2023
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