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Organization
MINGUS MOUNTAIN ESTATE RESIDENTIAL CENTER INC
Active
Organization
MINGUS MOUNTAIN ESTATE RESIDENTIAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY COPAS (EXECUTIVE DIRECTOR)
(602) 335-2000
Entity
Organization
Contact information
Practice address
15801 E DON CARLOS DR, PRESCOTT VALLEY, AZ 86315-4109
(602) 335-2068
(602) 335-2066
Mailing address
2517 N GREAT WESTERN DR STE P, PRESCOTT VALLEY, AZ 86314-2597
(602) 335-2068
(602) 335-2066
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH-312
AZ
Other
Enumeration date
08/01/2006
Last updated
06/19/2023
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