NPI 1174774608

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Organisation Emotionally Disturbed Childrens' Residential Treatment Facility Queen Creek, AZ

Practice location

Address: 1609 E Heather Dr, Queen Creek, AZ 85240-5682
Phone: (480) 393-0662
Fax: (602) 283-3476

Authorised official

Name: Kwadwo Kantanka
Title: Administrator/Ceo
Phone: (480) 393-0662

Registered specialties

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X Licence BH-3086 (AZ)

Other Residential Treatment Facility, Emotionally Disturbed Children providers in Arizona →

Registry record

NPI: 1174774608
Entity type: Organization
NPI issued: 2 Oct 2008
Record last updated: 2 Oct 2008

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.