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Organization
EAGLES NEST GROUP HOME, DBA
Active
Organization
EAGLES NEST GROUP HOME, DBA
Active
Other names
Eagles Nest Boys Residential Agency
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TED D MCCLURE I 6025681441 (EXECUTIVE-DIRECTOR)
(602) 568-1441
Entity
Organization
Contact information
Practice address
1802 E DOBBINS RD, PHOENIX, AZ 85042-8500
(602) 568-1441
(602) 268-4834
Mailing address
1802 E DOBBINS RD, PHOENIX, AZ 85042-8500
(602) 568-1441
(602) 268-4834
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH4442
DC
Other
Enumeration date
03/25/2014
Last updated
03/25/2014
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