Organization
MATTIE'S CARE HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATOYA J. LEE (CEO/ADMINISTRATOR)
(602) 686-0419
Entity
Organization
Contact information
Practice address
6823 W PLEASANT LN, LAVEEN, AZ 85339-2660
(602) 686-0419
(602) 687-9742
Mailing address
6823 W PLEASANT LN, LAVEEN, AZ 85339-2660
(602) 686-0419
(602) 687-9742
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4867
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148847
AHCCCS
AZ
Enumeration date
06/30/2016
Last updated
07/14/2016
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