Organization
HOME AWAY FROM HOME BEHAVIORAL HEALTH RESIDENTIAL FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TANYA M AYIYI (ADMINISTRATOR)
(623) 312-3485
Entity
Organization
Contact information
Practice address
8572 W PALO VERDE AVE, PEORIA, AZ 85345-5354
(623) 312-3485
Mailing address
8572 W PALO VERDE AVE, PEORIA, AZ 85345-5354
(623) 312-3485
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH4513
AZ
Other
Enumeration date
02/05/2015
Last updated
02/05/2015
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