Eagledancer Youth and Family Services, Inc.
Organization Active NPI Emotionally Disturbed Childrens' Residential Treatment Facility · White River, AZ
NPI 1730375668 · NPPES record last updated Mar 15, 2011
Key facts
- NPI
- 1730375668
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
- Legal business name
- EAGLEDANCER YOUTH AND FAMILY SERVICES, INC.
- Practice address
- 305 West Ben Gay
White River, AZ 85941 - Phone
- (928) 338-2312
- Fax
- (928) 338-2313
- NPI assigned
- Sep 25, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Charla C Hatch
- Title
- Executive Director
- Phone
- (928) 229-0560
Corporate family (same tax ID) 1
National Provider Directory
- Tax ID family
- Eagledancer Youth and Family Services Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | AZ | ||
| Emotionally Disturbed Childrens' Residential Treatment Facility | 322D00000X | AZ | Yes | |
| Substance Abuse Rehabilitation Facility | 324500000X | AZ |
Addresses
Primary practice location
305 West Ben Gay
White River, AZ 85941
Mailing address
1323 Lobo TRL
1323 Lobo Trail
Snowflake, AZ 85937-5407
Phone (928) 227-3950
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 263967 | Medicaid | AZ |
Other providers in White River, AZ
All providers in White River, AZ · Emotionally Disturbed Childrens' Residential Treatment Facility in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 15, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.