Fairlane Group Home LLC
NPI #1700528650 in Casa Grande, Arizona
Provider Information
- NPI Number
- 1700528650
- Entity Type
- Organization
- Organization Name
- Fairlane Group Home LLC
- Primary Specialty
- Psychiatric Residential Treatment Facility
- Enumeration Date
- Apr 11, 2022
- Last Updated
- Apr 12, 2022
Practice Location
- Address
- 821 W FAIRLANE CT
- City
- Casa Grande
- State
- Arizona
- ZIP Code
- 85122-6688
- Phone
- (602) 421-4663
Authorized Official
- Name
- MRS. GABRIELLA FOSTER, MAC, CHT
- Title
- DIRECTOR OF OPERATIONS
- Phone
- (602) 421-4663
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychiatric Residential Treatment Facility |
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