Fairlane Group Home LLC

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

Legal business name

FAIRLANE GROUP HOME LLC

Practice address

821 W Fairlane CT
Casa Grande, AZ 85122-6688

Phone

(602) 421-4663

Fax

(602) 610-5557

NPI assigned

Apr 11, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Gabriella Foster, MAC, CHT

Title

Director of Operations

Phone

(602) 421-4663

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649721600000",
    "number": "1700528650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16994 W RIO VISTA LN",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853387409",
            "telephone_number": "602-421-4663",
            "fax_number": "602-610-5557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 W FAIRLANE CT",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851226688",
            "telephone_number": "602-421-4663",
            "fax_number": "602-610-5557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRLANE GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-11",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A",
        "authorized_official_last_name": "FOSTER",
        "authorized_official_first_name": "GABRIELLA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "602-421-4663",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MAC, CHT"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric Residential Treatment Facility in Casa Grande, AZ
• Providers in Casa Grande, AZ by specialty
• Psychiatric Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; 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.