Organization
GOLDEN DREAM RESIDENTIAL CARE LLC
Active
Other names
N/A
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM OCITI MARINO (OWER)
(602) 299-9030
Entity
Organization
Contact information
Practice address
621 S 115TH DR, AVONDALE, AZ 85323-9141
(623) 433-8189
(623) 433-9678
Mailing address
621 S 115TH DR, AVONDALE, AZ 85323-9141
(623) 433-8189
(623) 433-9678
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
BH4619
AZ
Other
Enumeration date
08/21/2015
Last updated
08/21/2015
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