Organization
CHANGING LIVES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA PLUM (PARTNER)
(623) 337-2275
Entity
Organization
Contact information
Practice address
17637 W BUCHANAN ST, GOODYEAR, AZ 85338-2577
(623) 337-2275
(623) 440-6557
Mailing address
PO BOX 7405, GOODYEAR, AZ 85338-0641
(623) 337-2275
(623) 440-6557
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/21/2020
Last updated
12/21/2020
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