Organization
ESTRELLA VISTA RANCH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ERICA TAHSE PALACIOS (PRESIDENT)
(602) 206-7687
Entity
Organization
Contact information
Practice address
4911 EAST SILK WIND BLVD, DRAGOON, AZ 85609
(520) 586-9254
Mailing address
PO BOX 235, DRAGOON, AZ 85609-0235
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH-3062
AZ
Other
Enumeration date
06/10/2008
Last updated
06/10/2008
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