Charles Residential Care LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

BH4681 Issued in AZ

Legal business name

CHARLES RESIDENTIAL CARE LLC

Practice address

15813 W Monroe St
Goodyear, AZ 85338-6896

Phone

(623) 882-1294

NPI assigned

Oct 20, 2015

Last updated

Oct 20, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Eugenia Asota, RN

Title

Director

Phone

(309) 269-0798

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445299200000",
    "number": "1245602044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15561 W DEVONSHIRE AVE",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853957772",
            "telephone_number": "623-882-1294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15813 W MONROE ST",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853386896",
            "telephone_number": "623-882-1294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-20",
        "last_updated": "2015-10-20",
        "status": "A",
        "authorized_official_last_name": "ASOTA",
        "authorized_official_first_name": "EUGENIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "309-269-0798",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH4681",
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": "BH4681",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharad Chandrika, M.D.
• Joseph He Chang, D.D.S.
• Ryan Chang, PA-C
• Changing Lives
• Linda Chapman, LPN
• Paul Scott Charnetsky, M.D.
• Daniel D Charous, MD
• Genevieve Chavannes, SPEECH LANGUAGE PATH
• Viviane Che
• Howard K Chen, MD

• Mental Illness Community Based Residential Treatment Facility in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.