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General NPI Number Information
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NPI Number | 1649907148
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Entity Type | Organization
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Legal Business Name | RESIDENTIAL GROUPHOME SERVICES LLC
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 6102 S 37TH LN
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City | PHOENIX
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State | AZ
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Zip | 85041-5021
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Country | US
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Telephone | 602-718-8809
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Fax |
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Provider Business Mailing Address
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Address Line | 1805 E ALTA VISTA RD
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City | PHOENIX
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State | AZ
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Zip | 85042-4551
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Country | US
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Telephone | 602-718-8809
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Fax |
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Authorized Official
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Title or Position | OWNER /OPERATOR
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Name | ROBERT MCNEAL
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Credential | BS
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Telephone | 602-718-8809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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