Organization
DEFONSE FAMILY RESTORATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NADINE DEFONSE FANFAN (ASST ADMINISTRATOR/MANAGER)
(323) 412-2137
Entity
Organization
Contact information
Practice address
7812 W WOOD LN, PHOENIX, AZ 85043-1426
(310) 956-7616
Mailing address
7812 W WOOD LN, PHOENIX, AZ 85043-1426
(310) 956-7616
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/13/2020
Last updated
06/13/2020
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