Organization
FAIRLANE GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GABRIELLA FOSTER MAC, CHT (DIRECTOR OF OPERATIONS)
(602) 421-4663
Entity
Organization
Contact information
Practice address
821 W FAIRLANE CT, CASA GRANDE, AZ 85122-6688
(602) 421-4663
(602) 610-5557
Mailing address
16994 W RIO VISTA LN, GOODYEAR, AZ 85338-7409
(602) 421-4663
(602) 610-5557
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/11/2022
Last updated
04/12/2022
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