Organization
ROXBURY COMMONS RESIDENTIAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIYANA BRUTUS P.M.H.N.P, B.C. (OWNER)
(602) 235-0767
Entity
Organization
Contact information
Practice address
3847 W PORT ROYALE LN, PHOENIX, AZ 85053-4546
(602) 235-0767
Mailing address
PO BOX 1536, HIGLEY, AZ 85236-1536
(602) 235-0767
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/18/2016
Last updated
04/18/2016
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