Organization
HERON CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON KABUYE SSEGIMU (PROGRAM DIRECTOR)
(478) 978-2831
Entity
Organization
Contact information
Practice address
3246 E CARLA VISTA DR, GILBERT, AZ 85295-3424
(478) 978-2831
Mailing address
3246 E CARLA VISTA DR, GILBERT, AZ 85295-3424
(478) 978-2831
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/29/2022
Last updated
08/08/2023
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