NPI 1255484366

Big John Group Home

Organisation Emotionally Disturbed Childrens' Residential Treatment Facility El Mirage, AZ

Practice location

Address: 12514 N 126th Ln, El Mirage, AZ 85335-5206
Phone: (480) 202-2972
Fax: (623) 546-0161
Mailing address: 70 S Val Vista Dr STE A3 # 44, Gilbert, AZ 85296-1375

Authorised official

Name: Stephanie Kay Edwards
Title: Director of Operations
Phone: (480) 202-2972

Registered specialties

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X Licence 723636 (AZ)

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Registry record

NPI: 1255484366
Entity type: Organization
NPI issued: 19 Jan 2007
Record last updated: 22 Aug 2020

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.