CHARLES RESIDENTIAL CARE LLC (NPI# 1245602044) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245602044 |
| Entity Type | Organization |
| Organization Name | CHARLES RESIDENTIAL CARE LLC |
| Practice Address |
15813 W Monroe St Goodyear AZ 85338-6896 |
| Mailing Address |
15561 W Devonshire Ave Goodyear AZ 85395-7772 |
| Practice Telephone | 6238821294 |
| Mailing Telephone | 6238821294 |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2015-10-20 |
| Authorized Official Name | MRS. EUGENIA ASOTA (DIRECTOR) |
| Authorized Official Telephone | 3092690798 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 324500000X | Substance Abuse Rehabilitation Facility | BH4681 | AZ | Residential Treatment Facilities |
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | BH4681 | AZ | Residential Treatment Facilities |
| Street Address |
15813 W MONROE ST |
| City | GOODYEAR |
| State | AZ |
| Zip Code | 85338-6896 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295226884 | Caroline Chang | Dentist | 15530 W Roosevelt St Ste E106, Goodyear, AZ 85338 | 2018-05-20 |
| 1609376714 | Rosanna Alvarez | Licensed Practical Nurse | 17432 W Elaine Dr, Goodyear, AZ 85338 | 2018-02-15 |
| 1023534419 | Jennifer Elizabeth Lawrence Dixon | Social Worker | 319 N Lichfield Rd, Suite 105, Goodyear, AZ 85338 | 2017-08-17 |
| 1346774916 | Vanessa Castillo | Specialist/Technologist | 18035 W. Yuma Rd, Goodyear, AZ 85338 | 2017-04-20 |
| 1386008076 | Hope Behavioral Health Residential Care | Substance Abuse Rehabilitation Facility | 15985 W.williams Street, Goodyear, AZ 85338 | 2016-04-08 |
| 1952760241 | Jeremy John Abdul-haqq | Dentist | 15661 W Roosevelt St Ste 102, Goodyear, AZ 85338 | 2016-02-16 |
| 1417206897 | Kelly Renee Filo | Occupational Therapy Assistant | 10189 S. Hacienda Dr., Goodyear, AZ 85338 | 2012-08-31 |
| 1194015545 | Nancy Ann Amore | Licensed Practical Nurse | 15578 W Yuma Road, Goodyear, AZ 85338 | 2011-04-19 |
| 1932409208 | Chung Counihan | Pharmacist | 9890 S Estrella Parkway, Goodyear, AZ 85338 | 2010-11-02 |
| 1053611327 | Traven Anderson | Pharmacist | 9890 South Estrella Parkway, Goodyear, AZ 85338 | 2010-11-02 |
| Find all providers in zip 85338 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871008219 | Arizona Behavioral Care Homes LLC | Community Based Residential Treatment Facility, Mental Illness | 4349 N 161st Ave, Goodyear, AZ 85395-6439 | 2017-12-07 |
| 1538672076 | Martha's Residential Care LLC | Community Based Residential Treatment Facility, Mental Illness | 14256 W Fairmount Ave, Goodyear, AZ 85395-8428 | 2017-11-07 |
| 1265825418 | Arizona Behavioral Care Homes LLC | Community Based Residential Treatment Facility, Mental Illness | 16781 W Hilton Ave, Goodyear, AZ 85338-7402 | 2015-03-12 |
| 1578955886 | Arizona Behavioral Care Homes LLC | Community Based Residential Treatment Facility, Mental Illness | 1946 S 174th Ln, Goodyear, AZ 85338-1924 | 2015-02-23 |
| 1275971632 | Arizona Behavioral Care Homes LLC | Community Based Residential Treatment Facility, Mental Illness | 560 N 159th Ln, Goodyear, AZ 85338-3276 | 2013-06-07 |
| 1366710535 | Arizona Behavioral Care Homes LLC | Community Based Residential Treatment Facility, Mental Illness | 16800 W Roosevelt St, Goodyear, AZ 85338-7037 | 2011-12-02 |
| 1528360898 | Arizona Behavioral Care Homes LLC | Community Based Residential Treatment Facility, Mental Illness | 16575 W Roosevelt St, Goodyear, AZ 85338-6192 | 2010-11-18 |
| 1013141407 | Successful Journeys, LLC | Community Based Residential Treatment Facility, Mental Illness | 4434 N 153rd Ln, Goodyear, AZ 85395-6302 | 2009-05-13 |
| 1124685300 | Affinity Behavioral Care, LLC | Community Based Residential Treatment Facility, Mental Illness | 560 N 159th Ln, Goodyear, AZ 85338-3276 | 2019-05-23 |
| 1255998654 | Affinity Behavioral Care, LLC | Community Based Residential Treatment Facility, Mental Illness | 16800 W Roosevelt St, Goodyear, AZ 85338-7037 | 2019-05-22 |
| Find all providers in GOODYEAR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.