Organization
EASTER SEALS BLAKE FOUNDATION
Active
Other names
Agape House
Organization subpart
No
Provider details
NPI number
Authorized official
MARISSA S ARENDT (CFO)
(520) 327-1529
Entity
Organization
Contact information
Practice address
4454 E 3RD ST, TUCSON, AZ 85711-1189
(520) 881-3090
Mailing address
7750 E BROADWAY BLVD, STE. A200, TUCSON, AZ 85710-3901
(520) 327-1529
(520) 327-1836
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH-4429
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
881725
AHCCCS PROVIDER
AZ
01
—
BH4429
AZ BEHAVIORAL HEALTH RESIDENTIAL FACILITY LICENSE
AZ
Enumeration date
12/02/2013
Last updated
08/03/2021
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