Organization
SAN JUDAS GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IMELDA MELISSA NORIEGA (ADMINISTRATOR)
(602) 643-5932
Entity
Organization
Contact information
Practice address
5116 S 11TH AVE, PHOENIX, AZ 85041-2363
(602) 643-5932
(602) 281-6974
Mailing address
5415 S 5TH AVE, PHOENIX, AZ 85041-4000
(602) 643-5932
(602) 281-6974
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
ALH6076
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203799
—
AZ
Enumeration date
04/07/2010
Last updated
04/07/2010
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