Organization
RESIDENTIAL GROUPHOME SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MCNEAL BS (OWNER /OPERATOR)
(602) 718-8809
Entity
Organization
Contact information
Practice address
6102 S 37TH LN, PHOENIX, AZ 85041-5021
(602) 718-8809
Mailing address
1805 E ALTA VISTA RD, PHOENIX, AZ 85042-4551
(602) 718-8809
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103TA0400X
—
AZ
05
—
103TC0700X
—
AZ
05
—
103TC1900X
—
AZ
05
—
103TP2701X
—
AZ
Enumeration date
08/04/2022
Last updated
10/05/2023
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