Organization
PHA RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHALINA MITCHELL RN (OWNER)
(602) 502-6238
Entity
Organization
Contact information
Practice address
5312 W STARGAZER PL, LAVEEN, AZ 85339-4512
(602) 502-6238
Mailing address
5312 W STARGAZER PL, LAVEEN, AZ 85339-4512
(602) 502-6238
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
163W00000X
Registered Nurse
—
—
251B00000X
Case Management Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
04/01/2024
Last updated
04/02/2024
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