Organization
RESILIENT COMMUNITY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA NICHOLAS (OWNER)
(708) 541-5006
Entity
Organization
Contact information
Practice address
5039 N 57TH AVE APT 252, GLENDALE, AZ 85301-7461
(708) 541-5006
Mailing address
5039 N 57TH AVE APT 252, GLENDALE, AZ 85301-7461
(708) 541-5006
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
02/22/2021
Last updated
05/18/2021
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