Healthcare Provider Details

I. General information

NPI: 1093664120
Provider Name (Legal Business Name): RENE'S CARE FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 E MCDOWELL RD STE 2
PHOENIX AZ
85008-7492
US

IV. Provider business mailing address

4045 E MCDOWELL RD STE 2
PHOENIX AZ
85008-7492
US

V. Phone/Fax

Practice location:
  • Phone: 602-471-3769
  • Fax:
Mailing address:
  • Phone: 602-471-3769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VALERIE BULLOCK
Title or Position: OWNER
Credential:
Phone: 510-772-1117