Organization
GOOD SAMARITAN RESIDENTIAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIDIER TWAGIRAYEZU (ADMINISTRATOR)
(817) 480-3474
Entity
Organization
Contact information
Practice address
1536 E INOUYE DR, CASA GRANDE, AZ 85122-6590
(817) 480-3474
Mailing address
1536 E INOUYE DR, CASA GRANDE, AZ 85122-6590
(817) 480-3474
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH7786
AZDHS
AZ
Enumeration date
07/22/2022
Last updated
07/22/2022
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