Organization
I CARE GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIJAH SISSE (PROGRAM DIRECTOR)
(480) 302-1620
Entity
Organization
Contact information
Practice address
5529 E BLOOMFIELD RD, SCOTTSDALE, AZ 85254-4203
(480) 302-1620
Mailing address
130 N 110TH DR, AVONDALE, AZ 85323-3323
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH5232
AZ
Other
Enumeration date
08/02/2017
Last updated
08/03/2017
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