Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mary Group Home LLC

Organization Emotionally Disturbed Childrens' Residential Treatment Facility · NPI 1760342083

Mary Group Home LLC is an Emotionally Disturbed Childrens' Residential Treatment Facility in Phoenix, Arizona. Registered with an NPI since 2025.

In the registry since
2025
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

12643 N 22nd Ave
Phoenix, AZ 85029-2652
Phone: (480) 577-7777
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emotionally Disturbed Childrens' Residential Treatment Facility (primary) Taxonomy 322D00000X

Record details

NPI number1760342083
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Abdalla Elkhalifa — Ceo · (480) 577-7777
NPI enumeratedNovember 18, 2025
Last updated in NPPESNovember 18, 2025
Certification dateNovember 18, 2025
Mailing address12643 N 22nd Ave, Phoenix, AZ 85029-2652

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