# SUPPORTED LIVING SYSTEMS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pima House
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013065416
- **Authorized official:** DR. RICHARD ECK PHD (CEO)
- **Authorized official phone:** (520) 514-9888

## Contact information

- **Practice address:** 3327 E BROADWAY BLVD, TUCSON, AZ 85716-5858
- **Practice address phone:** (520) 318-0270
- **Mailing address:** 925 S CRAYCROFT RD, TUCSON, AZ 85711-7112
- **Mailing address phone:** (520) 514-9888
- **Mailing address fax:** (520) 514-9878

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | BH-1575 | AZ | Yes |

## Other

- **Enumeration date:** 01/08/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 434556 | AHCCS PROVIDER\# | AZ |
| 01 | — | BH-1575 | AZ BEHAVIORAL LICENSE \# | AZ |