Eagles Nest Group Home, Dba

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

BH4442 Issued in DC

Legal business name

EAGLES NEST GROUP HOME, DBA

Practice address

1802 E Dobbins Rd
Phoenix, AZ 85042-8500

Phone

(602) 568-1441

Fax

(602) 268-4834

NPI assigned

Mar 25, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Ted D McClure I, 6025681441

Title

Executive-Director

Phone

(602) 568-1441

Specialties & licenses 1

Addresses

Other names 1

• Eagles Nest Boys Residential Agency Other name

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

{
    "created_epoch": "1395705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395705600000",
    "number": "1639596927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 E DOBBINS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850428500",
            "telephone_number": "602-568-1441",
            "fax_number": "602-268-4834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 E DOBBINS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850428500",
            "telephone_number": "602-568-1441",
            "fax_number": "602-268-4834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLES NEST GROUP HOME, DBA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-25",
        "last_updated": "2014-03-25",
        "status": "A",
        "authorized_official_last_name": "MCCLURE",
        "authorized_official_first_name": "TED",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE-DIRECTOR",
        "authorized_official_telephone_number": "602-568-1441",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "6025681441"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "DC",
            "license": "BH4442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagles Nest Boys Residential Agency",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Phoenix, AZ
• Providers in Phoenix, 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 Mar 25, 2014; 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.