Organization
VALLEY INDEPENDENT RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AUGUSTINE SAAH MCCABE SR. (OWER)
(623) 907-1142
Entity
Organization
Contact information
Practice address
6408 W GROSS AVE, PHOENIX, AZ 85043
(623) 907-1142
(623) 907-1143
Mailing address
6408 W GROSS AVE, PHOENIX, AZ 85043-5778
(623) 907-1142
(623) 907-1143
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4203
AZ
Other
Enumeration date
04/16/2013
Last updated
04/16/2013
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