1. Home
  2. Directory
  3. Arizona
  4. Queen Creek
  5. Community Behavioral Health
  6. NPI Profile

FORTITUDE 611 LLC
NPI 1003504390
Community/Behavioral Health in Queen Creek, AZ

Active since April 25, 2023
25062 S 190TH ST, QUEEN CREEK, AZ 85142(480) 329-0707 Get Directions Write a Review

NPPES record last updated: April 26, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Fortitude 611 Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FORTITUDE 611 LLC (NPI 1003504390) is a healthcare organization registered as a community/behavioral health in Queen Creek, Arizona and active in the NPI registry since April 2023. The organization lists Jaime Ingram, Owner, as its authorized official.

NPPES Registry Identity

NPI1003504390
Entity TypeOrganization
Primary Taxonomy251S00000X
Legal Business NameFORTITUDE 611 LLC
Location Address25062 S 190TH STQueen Creek, AZ 85142-5668
Mailing Address25062 S 190th StQueen Creek, AZ 85142-5668 · (480) 329-0707
Phone(480) 329-0707
Organization SubpartNo
Authorized OfficialJaime IngramOwner · (480) 329-0707
Enumeration DateApril 25, 2023
Last NPPES UpdateApril 26, 2023
NPPES CertifiedApril 26, 2023
✔ NPI 1003504390 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCommunity/Behavioral HealthAgencies
Taxonomy Code251S00000X
Definition
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
Also ListedCommunity Based Residential Treatment Facility, Mental IllnessTaxonomy 320800000X
25062 S 190TH ST, Queen Creek, AZ 85142
Open in Google Maps ↗

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JAIME INGRAM
Community Health Worker
25062 S 190TH ST
QUEEN CREEK, AZ 85142
Maricopa County (480) 329-0707

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fortitude 611 LLC's NPI number?

The NPI number for Fortitude 611 LLC is 1003504390. It was assigned to this organization in the NPPES registry on April 25, 2023.

Where is Fortitude 611 LLC located?

Fortitude 611 LLC is located at 25062 S 190th St, Queen Creek, AZ 85142. The listed phone number is (480) 329-0707.

What is Fortitude 611 LLC's specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

When was this NPI record last updated?

The NPPES record for Fortitude 611 LLC was last updated on April 26, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.