Healthcare Provider Details

I. General information

NPI: 1699648493
Provider Name (Legal Business Name): R.E.A.L. CARE OF AZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 W CHARLESTON AVE
PHOENIX AZ
85023-2507
US

IV. Provider business mailing address

1532 W CHARLESTON AVE
PHOENIX AZ
85023-2507
US

V. Phone/Fax

Practice location:
  • Phone: 480-597-3870
  • Fax: 480-687-9460
Mailing address:
  • Phone: 480-597-3870
  • Fax: 480-687-9460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RYAN KETCHUM
Title or Position: MANAGER
Credential:
Phone: 714-473-0965