Individual
LEIGHANN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
GROUP HOME OWNER
Contact information
Practice address
1958 E RENEGADE TRL, SAN TAN VALLEY, AZ 85143-4460
(928) 250-9436
Mailing address
270 E HUNT HWY STE 16-226, SAN TAN VALLEY, AZ 85143-6011
(928) 250-9436
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
AZ
385H00000X
Respite Care
—
—
Other
Enumeration date
03/10/2022
Last updated
06/30/2023
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