NPI 1780275537

Desert Agave Homes LLC

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Avondale, AZ

Practice location

Address: 810 S 124th Ave, Avondale, AZ 85323-8490
Phone: (623) 242-7962
Mailing address: 3403 E Diamond Ave, Mesa, AZ 85204-4017

Authorised official

Name: Madison Shaun Brown
Title: Owner
Phone: (646) 460-1913

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X

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Registry record

NPI: 1780275537
Entity type: Organization
NPI issued: 3 Feb 2021
Record last updated: 3 Feb 2021

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.