Organization
MINGUS MOUNTAIN ESTATE RESIDENTIAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY COPAS (EXECUTIVE DIRECTOR)
(602) 335-2000
Entity
Organization
Contact information
Practice address
15801 E DON CARLOS DR, PRESCOTT VALLEY, AZ 86315-4109
(602) 335-2068
(602) 335-2066
Mailing address
2517 N GREAT WESTERN DR STE P, PRESCOTT VALLEY, AZ 86314-2597
(602) 335-2068
(602) 335-2066
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH-312
AZ
Other
Enumeration date
08/01/2006
Last updated
06/19/2023
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