Organization
LEGENDARY FAMILY CARE COMPANY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELANI SELLERS (CEO)
(414) 731-9004
Entity
Organization
Contact information
Practice address
263 W BOBCAT CT, CASA GRANDE, AZ 85122-1043
(414) 731-9004
Mailing address
263 W BOBCAT CT, CASA GRANDE, AZ 85122-1043
(414) 731-9004
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
—
BH7573
AZ DEPARTMENT OF HEALTH SERVICES
AZ
Enumeration date
05/11/2022
Last updated
05/11/2022
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