Organization
EUREKA ANNEX RESIDENCE
Active
Parent organization
EUREKA IMPERIAL RESIDENCE
Organization subpart
Yes
Provider details
NPI number
Legal business name
EUREKA IMPERIAL RESIDENCE
Authorized official
MR. CORNELIUS TANYI (PROGRAM DIRECTOR)
(480) 264-2647
Entity
Organization
Contact information
Practice address
2668 S HERITAGE DR, GILBERT, AZ 85295-7164
(480) 264-2647
Mailing address
1740 S HERITAGE DR, GILBERT, AZ 85295-4851
(480) 264-2647
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
02/17/2014
Last updated
02/17/2014
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