# EAGLEDANCER YOUTH AND FAMILY SERVICES, INC.

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

## Provider details

- **NPI number:** 1730375668
- **Authorized official:** MRS. CHARLA C HATCH (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (928) 229-0560

## Contact information

- **Practice address:** 305 WEST BEN GAY, WHITE RIVER, AZ 85941
- **Practice address phone:** (928) 338-2312
- **Practice address fax:** (928) 338-2313
- **Mailing address:** 1323 LOBO TRL, 1323 LOBO TRAIL, SNOWFLAKE, AZ 85937-5407
- **Mailing address phone:** (928) 227-3950

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | — | AZ | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | AZ | Yes |
| 324500000X | Substance Abuse Rehabilitation Facility | — | AZ | — |

## Other

- **Enumeration date:** 09/25/2007
- **Last updated:** 03/15/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 263967 | — | AZ |