Organization
EUREKA IMPERIAL RESIDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORNELIUS EBAI TANYI (EXECUTIVE DIRECTOR)
(480) 375-5192
Entity
Organization
Contact information
Practice address
1740 S HERITAGE DRIVE, GILBERT, AZ 85296
(480) 264-2647
(480) 264-2647
Mailing address
7110 S CHAMPAGNE WAY, GILBERT, AZ 85298-9122
(480) 375-5192
(480) 821-7860
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH3319
AZ
Other
Enumeration date
07/29/2009
Last updated
07/29/2009
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