NPI 1003504390
Fortitude 611 LLC
Practice location
- Address
- 25062 S 190th St, Queen Creek, AZ 85142-5668
- Phone
- (480) 329-0707
Authorised official
- Name
- Jaime Ingram
- Title
- Owner
- Phone
- (480) 329-0707
Registered specialties (2)
Community/Behavioral Health Agency
Primary
Mental Illness Community Based Residential Treatment Facility
Registry record
- NPI
- 1003504390
- Entity type
- Organization
- NPI issued
- 25 Apr 2023
- Record last updated
- 26 Apr 2023
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.