Healthcare Provider Details

I. General information

NPI: 1699617068
Provider Name (Legal Business Name): BEAUTIFUL MIND RESIDENTIAL HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 W HAYWARD AVE
PHOENIX AZ
85051-6544
US

IV. Provider business mailing address

3135 W HAYWARD AVE
PHOENIX AZ
85051-6544
US

V. Phone/Fax

Practice location:
  • Phone: 602-708-2897
  • Fax:
Mailing address:
  • Phone: 602-708-2897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN RICHARDSON
Title or Position: MANAGER
Credential:
Phone: 602-708-2897