Organization
MARTHA'S RESIDENTIAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAFFIATU S TUNIS PHD (PROGRAM DIRECTOR)
(480) 217-6996
Entity
Organization
Contact information
Practice address
8572 W PALO VERDE AVE, PEORIA, AZ 85345-5354
(480) 217-6996
(480) 452-0243
Mailing address
22958 W PIMA ST, BUCKEYE, AZ 85326-8734
(623) 271-8248
(480) 452-0243
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4469
AZ
320800000X
Mental Illness Community Based Residential Treatment Facility
BH4907
AZ
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH6971
LICENSE
AZ
Enumeration date
07/08/2014
Last updated
08/16/2021
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