Organization
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Organization subpart
No
Provider details
NPI number
Authorized official
TINA DARLENE EMBREE LPN (ADMINISTRATOR)
14802676914
Entity
Organization
Contact information
Practice address
8784 E DESERT LUPINE PL, TUCSON, AZ 85715-5911
(480) 267-6914
(520) 344-8892
Mailing address
994 S HARRISON RD, TUCSON, AZ 85748-6608
(520) 721-1887
(520) 344-8892
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
BH4977
AZ
Other
Enumeration date
09/07/2016
Last updated
09/07/2016
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