Healthcare Provider Details

I. General information

NPI: 1134095573
Provider Name (Legal Business Name): GODS ONLY CHOICE CITY OF REFUGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/18/2025
Certification Date: 10/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 W MONROE ST
PEORIA AZ
85345-6440
US

IV. Provider business mailing address

3342 S 257TH DR # 663607
BUCKEYE AZ
85326-1832
US

V. Phone/Fax

Practice location:
  • Phone: 480-788-4557
  • Fax:
Mailing address:
  • Phone: 480-788-4557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHARLETTE DANYELLE ONLY-GRANT
Title or Position: CEO/FOUNDER
Credential:
Phone: 708-265-4447