Organization
DHARMA RESIDENTIAL AZ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CERMILLIA WILLIAMS MSW,MBA (CEO)
(314) 494-7603
Entity
Organization
Contact information
Practice address
19118 N SAN JUAN ST, MARICOPA, AZ 85138-2532
(314) 494-7603
Mailing address
19118 N SAN JUAN ST, MARICOPA, AZ 85138-2532
(314) 494-7603
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Enumeration date
05/13/2025
Last updated
05/13/2025
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