Premium Residential LLC
NPI #1235859869 in Casa Grande, Arizona
Provider Information
- NPI Number
- 1235859869
- Entity Type
- Organization
- Organization Name
- Premium Residential LLC
- Primary Specialty
- Community Based Residential Treatment Facility, Mental Illness
- Enumeration Date
- Sep 1, 2022
- Last Updated
- Aug 26, 2024
Practice Location
- Address
- 3545 N CINNABAR PL
- City
- Casa Grande
- State
- Arizona
- ZIP Code
- 85122
- Phone
- (346) 754-4511
Authorized Official
- Name
- KESIENA ERUOTOR
- Title
- ADMINISTRATOR
- Phone
- (346) 754-4511
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Mental Illness |
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