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Organization
EAGLEDANCER YOUTH AND FAMILY SERVICES, INC.
Active
Organization
EAGLEDANCER YOUTH AND FAMILY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHARLA C HATCH (EXECUTIVE DIRECTOR)
(928) 229-0560
Entity
Organization
Contact information
Practice address
305 WEST BEN GAY, WHITE RIVER, AZ 85941
(928) 338-2312
(928) 338-2313
Mailing address
1323 LOBO TRL, 1323 LOBO TRAIL, SNOWFLAKE, AZ 85937-5407
(928) 227-3950
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
AZ
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
AZ
324500000X
Substance Abuse Rehabilitation Facility
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263967
—
AZ
Enumeration date
09/25/2007
Last updated
03/15/2011
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