Provider Demographics
NPI:1790438638
Name:FONUTCHI, FRANKLIN
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:
Last Name:FONUTCHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 W AVALON CANYON DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6706
Mailing Address - Country:US
Mailing Address - Phone:240-660-6597
Mailing Address - Fax:
Practice Address - Street 1:1087 W AVALON CANYON DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6706
Practice Address - Country:US
Practice Address - Phone:240-660-6597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness