Fairlane Group Home LLC
Psychiatric Residential Treatment Facility in Casa Grande, AZ. Organization (NPI-2).
NPI number1700528650
StatusActive
Last updated in NPPESApr 12, 2022
Details
- NPI
- 1700528650
- Entity type
- Organization (NPI-2)
- Legal business name
- Fairlane Group Home LLC
- Organization subpart
- No
- Enumeration date
- Apr 11, 2022
- Certification date
- Apr 12, 2022
- Last updated
- Apr 12, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 323P00000X | Psychiatric Residential Treatment Facility | – | – | Yes |
Practice location
821 W Fairlane CtCasa Grande, AZ 85122-6688
Phone 602-421-4663 · Fax 602-610-5557
Mailing address
16994 W Rio Vista LnGoodyear, AZ 85338-7409
Phone 602-421-4663 · Fax 602-610-5557
Authorized official
Gabriella Foster
Director Of Operations
6024214663
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All 9 Psychiatric Residential Treatment Facility providers in Casa Grande · All 1,403 providers in Casa Grande
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