Fortitude 611 LLC
NPI #1003504390 in Queen Creek, Arizona
Provider Information
- NPI Number
- 1003504390
- Entity Type
- Organization
- Organization Name
- Fortitude 611 LLC
- Primary Specialty
- Community/Behavioral Health
- Enumeration Date
- Apr 25, 2023
- Last Updated
- Apr 26, 2023
Practice Location
- Address
- 25062 S 190TH ST
- City
- Queen Creek
- State
- Arizona
- ZIP Code
- 85142-5668
- Phone
- (480) 329-0707
Authorized Official
- Name
- JAIME INGRAM
- Title
- OWNER
- Phone
- (480) 329-0707
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Mental Illness |
| Community/Behavioral Health |
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