Organization
EXCLUSIVE CERTIFIED RESIDENTIAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAYA ROYCE (OWNER)
(623) 285-9595
Entity
Organization
Contact information
Practice address
3744 MARTINGALE DR, KINGMAN, AZ 86409-2994
(928) 255-1747
(928) 255-1741
Mailing address
33105 N 23RD AVE, PHOENIX, AZ 85085-5088
(623) 285-9595
(928) 255-1741
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4985
AZ
Other
Enumeration date
10/12/2016
Last updated
10/12/2016
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