Organization
MARTHA'S RESIDENTIAL CARE LLC
Active
Parent organization
MARTHA'S RESIDENTIAL CARE LLC
Other names
Martha's Residential Care LLC - Fairmount House
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARTHA'S RESIDENTIAL CARE LLC
Authorized official
SAFFIATU S TUNIS (PROGRAM DIRECTOR)
(623) 271-8248
Entity
Organization
Contact information
Practice address
14256 W FAIRMOUNT AVE, GOODYEAR, AZ 85395-8428
(480) 217-6996
(480) 452-0243
Mailing address
22958 W PIMA ST, BUCKEYE, AZ 85326-8734
(623) 271-8248
(480) 452-0243
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH5302
AZ
Other
Enumeration date
11/07/2017
Last updated
11/07/2017
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