Alta Vista Group Home

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

BH2414 Issued in AZ

Legal business name

ALTA VISTA GROUP HOME

Practice address

4108 E Ramsey Rd
Hereford, AZ 85615-8917

Phone

(520) 378-6466

Fax

(520) 378-6553

NPI assigned

Sep 26, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Brooke E Balch

Title

Cfo

Phone

(256) 880-3339

Specialties & licenses 1

Addresses

Other names 1

• Three Springs, Inc. Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215038757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4108 E RAMSEY RD",
            "city": "HEREFORD",
            "state": "AZ",
            "postal_code": "856158917",
            "telephone_number": "520-378-6466",
            "fax_number": "520-378-6553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4108 E RAMSEY RD",
            "city": "HEREFORD",
            "state": "AZ",
            "postal_code": "856158917",
            "telephone_number": "520-378-6466",
            "fax_number": "520-378-6553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA VISTA GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BALCH",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "256-880-3339",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AZ",
            "license": "BH2414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Three Springs, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Erik Arellano Sr., M.D.
• Jennifer Kay Barnett, PTA
• Lisa Ann Bilek, NP
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• Emotionally Disturbed Childrens' Residential Treatment Facility in Hereford, AZ
• Providers in Hereford, AZ by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.