National Provider Identifier Database

PHA RESIDENTIAL LLC
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.

Contact Information

PHA RESIDENTIAL LLC
5312 W STARGAZER PL
LAVEEN VILLAGE, AZ  85339-4512
Phone: 602-502-6238
Fax:
Website:
Specialty Taxonomy Code
* Community Based Residential Treatment Facility, Mental Illness 320800000X
Adult Mental Health 261QM0850X
Case Management 251B00000X
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities 320900000X
Community/Behavioral Health 251S00000X
Counselor 101Y00000X
Health Service 261QH0100X
Mental Health (Including Community Mental Health Center) 261QM0801X
Psychiatric Residential Treatment Facility 323P00000X
Public Health or Welfare 251K00000X
Registered Nurse 163W00000X
Residential Treatment Facility, Intellectual and/or Developmental Disabilities 320600000X
Substance Abuse Disorder Rehabilitation Facility 324500000X
Substance Abuse Treatment, Children 3245S0500X

* Indicates primary specialty

NPI Profile & details for PHA RESIDENTIAL LLC

NPI Number 1396597753
Legal business name
LBN		 PHA RESIDENTIAL LLC
Authorized official PHALINA MITCHELL - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 04/01/2024
Last updated 04/02/2024 - About 2 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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