Organization
DESERT AGAVE HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MADISON SHAUN BROWN (OWNER)
(646) 460-1913
Entity
Organization
Contact information
Practice address
810 S 124TH AVE, AVONDALE, AZ 85323-8490
(623) 242-7962
Mailing address
3403 E DIAMOND AVE, MESA, AZ 85204-4017
(646) 460-1913
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/03/2021
Last updated
02/03/2021
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