Organization
SUPPORTED LIVING SYSTEMS
Active
Organization
SUPPORTED LIVING SYSTEMS
Active
Other names
Agape House
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD ECK PHD (CEO)
(520) 514-9888
Entity
Organization
Contact information
Practice address
4454 E 3RD ST, TUCSON, AZ 85711-1189
(520) 320-8866
Mailing address
925 S CRAYCROFT RD, TUCSON, AZ 85711-7112
(520) 514-9888
(520) 514-9878
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH-2719
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122468
AHCCCS PROVIDER #
AZ
01
—
BH-2719
AZ BEHAVIORAL LICENSE #
AZ
Enumeration date
01/09/2007
Last updated
08/22/2020
Update your record
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