# HOME AWAY FROM HOME BEHAVIORAL HEALTH RESIDENTIAL FACILITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053702563
- **Authorized official:** MRS. TANYA M AYIYI (ADMINISTRATOR)
- **Authorized official phone:** (623) 312-3485

## Contact information

- **Practice address:** 8572 W PALO VERDE AVE, PEORIA, AZ 85345-5354
- **Practice address phone:** (623) 312-3485
- **Mailing address:** 8572 W PALO VERDE AVE, PEORIA, AZ 85345-5354
- **Mailing address phone:** (623) 312-3485

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | BH4513 | AZ | Yes |

## Other

- **Enumeration date:** 02/05/2015
- **Last updated:** 02/05/2015