DARRELL LEMONT ELLIS

CASA GRANDE, AZ
NPI1174925424
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy320800000X Community Based Residential Treatment Facility, Mental Illness
(Licence: AZ  BH-4483)
Enumeration Date2014-09-18
Last Update Date2014-09-18
Business Address
Mr. DARRELL LEMONT ELLIS Administrator
304 N LINCOLN AVE
CASA GRANDE, AZ 85122-4634
Phone number: 480-560-8924
Mailing Address
Mr. DARRELL LEMONT ELLIS Administrator
304 N. LINCOLN AVE
CASA GRANDE, AZ 85122
Phone number: 480-560-8924
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