Organization
SUPPORTED LIVING SYSTEMS
Active
Other names
Kachina House
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD ECK PHD (CEO)
(520) 514-9888
Entity
Organization
Contact information
Practice address
5626 E 2ND ST, TUCSON, AZ 85711-1415
(520) 750-8249
Mailing address
925 S CRAYCROFT RD, TUCSON, AZ 85711-7112
(520) 514-9888
(520) 514-9878
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH-1447
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
492752
AHCCCS PROVIDER #
AZ
01
—
BH-1447
AZ BEHAVIORAL LICENSE #
AZ
Enumeration date
01/09/2007
Last updated
08/22/2020
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