Organization
CAP X-MONTECITO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEATRA JOHNSON (EXECUTIVE DIRECTOR)
(623) 972-1400
Entity
Organization
Contact information
Practice address
17271 N 87TH AVE, PEORIA, AZ 85382-2777
(623) 972-1400
(623) 972-7470
Mailing address
17271 N 87TH AVE, PEORIA, AZ 85382-2777
(623) 972-1400
(623) 972-7470
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
311Z00000X
Custodial Care Facility
Primary
—
—
Other
Enumeration date
08/27/2024
Last updated
08/27/2024
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