Organization
FAY'S HOUSE 1,2,3 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEE'ANNA MARIE MCQUILLER (CHIEF ADMINISTRATOR)
(602) 304-0316
Entity
Organization
Contact information
Practice address
408 W BEVERLY RD, PHOENIX, AZ 85041-8111
(602) 304-0316
(602) 276-0138
Mailing address
408 W BEVERLY RD, PHOENIX, AZ 85041-8111
(602) 304-0316
(602) 276-0138
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH 2693
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146283
—
AZ
Enumeration date
05/10/2007
Last updated
01/04/2011
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