# EAGLES NEST GROUP HOME, DBA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Eagles Nest Boys Residential Agency
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639596927
- **Authorized official:** MR. TED D MCCLURE I 6025681441 (EXECUTIVE-DIRECTOR)
- **Authorized official phone:** (602) 568-1441

## Contact information

- **Practice address:** 1802 E DOBBINS RD, PHOENIX, AZ 85042-8500
- **Practice address phone:** (602) 568-1441
- **Practice address fax:** (602) 268-4834
- **Mailing address:** 1802 E DOBBINS RD, PHOENIX, AZ 85042-8500
- **Mailing address phone:** (602) 568-1441
- **Mailing address fax:** (602) 268-4834

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | BH4442 | DC | Yes |

## Other

- **Enumeration date:** 03/25/2014
- **Last updated:** 03/25/2014