Provider Demographics
NPI:1225788904
Name:ASSURED DIGNITY RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:ASSURED DIGNITY RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BADEJOKO
Authorized Official - Middle Name:
Authorized Official - Last Name:ODETOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-512-8548
Mailing Address - Street 1:6850 W CARSON RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7025
Mailing Address - Country:US
Mailing Address - Phone:623-512-8548
Mailing Address - Fax:
Practice Address - Street 1:6850 W CARSON RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7025
Practice Address - Country:US
Practice Address - Phone:623-512-8548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness