Organization
GUARDIANS OF THE FOUR CORNERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA DERY PHMNP-BC (OWNER)
(480) 220-5864
Entity
Organization
Contact information
Practice address
38039 N DENA DR, SAN TAN VALLEY, AZ 85140-4426
(480) 220-5864
Mailing address
109 S NEELY ST, GILBERT, AZ 85233-5830
(480) 220-5864
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Enumeration date
10/14/2022
Last updated
04/10/2024
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