Organization
MATTIE'S CARE HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATOYA JANELLE LEE CAO/PA (CEO)
(602) 686-0419
Entity
Organization
Contact information
Practice address
8015 S 23RD DR, PHOENIX, AZ 85041-7650
(602) 686-0419
Mailing address
6823 W PLEASANT LN, LAVEEN, AZ 85339-2660
(602) 686-0419
(602) 585-9302
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/30/2024
Last updated
05/30/2024
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