Fortitude 611 Llc | |
25062 S 190th St Queen Creek AZ 85142-5668 | |
(480) 329-0707 | |
Not Available |
Full Name | Fortitude 611 Llc |
---|---|
Speciality | Community/behavioral Health |
Location | 25062 S 190th St, Queen Creek, Arizona |
Authorized Official Name and Position | Jaime Ingram (OWNER) |
Authorized Official Contact | 4803290707 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Fortitude 611 Llc 25062 S 190th St Queen Creek AZ 85142-5668 Ph: (480) 329-0707 | Fortitude 611 Llc 25062 S 190th St Queen Creek AZ 85142-5668 Ph: (480) 329-0707 |
NPI Number | 1003504390 |
---|---|
Provider Enumeration Date | 04/25/2023 |
Last Update Date | 04/26/2023 |
Certification Date | 04/26/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003504390 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Secondary |
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