Organization
NEW CASA DE AMIGAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH LYLE FOX (EXECUTIVE DIRECTOR)
(602) 265-9987
Entity
Organization
Contact information
Practice address
1648 W COLTER ST # 8, PHOENIX, AZ 85015-3022
(602) 265-9987
(602) 265-9983
Mailing address
1648 W COLTER ST # 8, PHOENIX, AZ 85015-3022
(602) 265-9987
(602) 265-9983
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
BH 1611
AZ
Other
Enumeration date
09/16/2006
Last updated
08/22/2020
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