NPI 1053702563

Home Away From Home Behavioral Health Residential Facility

Organisation Emotionally Disturbed Childrens' Residential Treatment Facility Peoria, AZ

Practice location

Address: 8572 W Palo Verde Ave, Peoria, AZ 85345-5354
Phone: (623) 312-3485

Authorised official

Name: Tanya M Ayiyi
Title: Administrator
Phone: (623) 312-3485

Registered specialties

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X Licence BH4513 (AZ)

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Registry record

NPI: 1053702563
Entity type: Organization
NPI issued: 5 Feb 2015
Record last updated: 5 Feb 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.