Provider Demographics
NPI:1699346262
Name:CELTIC DDD HOMES LLC
Entity type:Organization
Organization Name:CELTIC DDD HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABDILATIF
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-323-4616
Mailing Address - Street 1:PO BOX 2382
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85244-2382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1641 E GARY DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-1665
Practice Address - Country:US
Practice Address - Phone:602-323-4616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities