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General NPI Number Information
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NPI Number | 1346954112
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Entity Type | Organization
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Legal Business Name | FORRESTER BEHAVIORAL HEALTH HOMES
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 36014 W MADRID AVE
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City | MARICOPA
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State | AZ
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Zip | 85138-5457
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Country | US
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Telephone | 480-296-9314
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Fax |
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Provider Business Mailing Address
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Address Line | 555 S GALLERIA WAY UNIT 368
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City | CHANDLER
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State | AZ
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Zip | 85226-1543
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Country | US
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Telephone | 480-296-9314
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JESSICA GRACE FORRESTER
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Credential |
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Telephone | 480-296-9314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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