Organization
MINGUS MOUNTAIN ESTATE RESIDENCIAL CENTER, INC.
Active
Organization
MINGUS MOUNTAIN ESTATE RESIDENCIAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS BANKEN (EXECUTIVE DIRECTOR)
(602) 335-2000
Entity
Organization
Contact information
Practice address
HC 76 HWY 89 A N JUNCTION 151, PRESCOTT VALLEY, AZ 86312-6485
(602) 335-2000
Mailing address
PO BOX 26485, PRESCOTT VALLEY, AZ 86312-6485
(602) 335-2000
(602) 249-1311
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
BH-1487
AZ
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
BH-312
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
497744
—
AZ
05
—
498057
—
AZ
05
—
590118
—
AZ
Enumeration date
06/05/2007
Last updated
09/11/2025
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