Organization
FAMILY CARE BEHAVIORAL HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALDINE GOODALL (CEO)
(623) 800-9688
Entity
Organization
Contact information
Practice address
7357 W VALENCIA DR, LAVEEN, AZ 85339-3469
(623) 800-9688
Mailing address
7357 W VALENCIA DR, LAVEEN, AZ 85339-3469
(623) 800-9688
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH6801
AZDHS
AZ
Enumeration date
08/18/2021
Last updated
08/18/2021
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