Organization
EUREKA IMPERIAL RESIDENCE
Active
Parent organization
EUREKA IMPERIAL RESIDENCE
Other names
CHANGING LIVES OUTPATIENT CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
EUREKA IMPERIAL RESIDENCE
Authorized official
CORNELIUS TANYI (PROGRAM DIRECTOR)
(480) 264-2647
Entity
Organization
Contact information
Practice address
633 E RAY ROAD, GILBERT, AZ 85295
(480) 264-2647
Mailing address
633 E RAY RD, GILBERT, AZ 85296-4200
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
09/08/2017
Last updated
09/08/2017
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