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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