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Mr. Darrell Lemont Ellis JR., ADMINISTRATOR
Mental Illness Community Based Residential Treatment Facility in Casa Grande, Arizona
NPI 1174925424

Darrell Lemont Ellis JR. is a Mental Illness Community Based Residential Treatment Facility based in Casa Grande, AZ. Darrell Lemont Ellis JR. practices in Casa Grande, AZ and has the professional credentials of ADMINISTRATOR. The NPI Number for Darrell Lemont Ellis JR. is 1174925424 and holds a License No. BH-4483 (Arizona).

The current practice location address for Darrell Lemont Ellis JR. is 304 N Lincoln Ave, Casa Grande, AZ and can be reached out via phone at 480-560-8924.

Location: 304 N Lincoln Ave, Casa Grande, AZ, 85122
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1174925424
Provider Name
Darrell Lemont Ellis JR.
Credential
ADMINISTRATOR
Provider Entity Type
Individual
Gender
Male
Address
304 N Lincoln Ave, Casa Grande, AZ, 85122
Phone Number
480-560-8924
Fax Number
Provider Enumeration Date
09/18/2014
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
304 N Lincoln Ave
City
Casa Grande
State
Arizona
Zip
85122-4634
Phone Number
480-560-8924
Fax Number
person
Provider Business Mailing Address Details
Address
304 N Lincoln Ave
City
Casa Grande
State
Arizona
Zip
85122-4634
Phone Number
480-560-8924
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Mental Illness
Speciality
-
Taxonomy
320800000X
License No.
BH-4483 (Arizona)
Definition
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
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