Organization · NPI-2

Eureka Annex Residence

Community Based Residential Treatment Facility, Mental Illness · Gilbert, AZ

NPI number1043634769
StatusActive
Last updated in NPPESFeb 17, 2014

Details

NPI
1043634769
Entity type
Organization (NPI-2)
Legal business name
Eureka Annex Residence
Organization subpart
Yes
Enumeration date
Feb 17, 2014
Last updated
Feb 17, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
320800000X Community Based Residential Treatment Facility, Mental Illness––Yes
324500000X Substance Abuse Rehabilitation Facility––

Practice location

2668 S Heritage Dr
Gilbert, AZ 85295-7164

Phone 480-264-2647

Mailing address

1740 S Heritage Dr
Gilbert, AZ 85295-4851

Phone 480-264-2647

Authorized official

Cornelius Tanyi
Program Director
4802642647

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