MEDICARE: LAMAC HOUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	BH3862	AZ

General Provider Information

NPI Number	:	1184911976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAMAC HOUSE

Provider Business Mailing Address
First Line	:	4324 E FRIESS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-5802
Country	:	US
Telephone Number	:	647-836-0887
Fax Number	:

Provider Business Practice Location Address
First Line	:	4324 E FRIESS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-5802
Country	:	US
Telephone Number	:	647-836-0887
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/ADMINISTRATOR
Name	:	MS. JOYCE ODONGO
Credential	:	REGISTERED NURSE
Telephone Number	:	647-836-0887

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	06/30/2011

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Directions to “LAMAC HOUSE ” Practice Location

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