Organization · NPI-2
Tri-Phase Group Home INC
Counselor · Gilbert, AZ
NPI number1396914735
StatusActive
Last updated in NPPESJun 26, 2008
Details
- NPI
- 1396914735
- Entity type
- Organization (NPI-2)
- Legal business name
- Tri-Phase Group Home INC
- Organization subpart
- No
- Enumeration date
- Feb 28, 2008
- Last updated
- Jun 26, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101Y00000X | Counselor | BH-1914 | AZ | Yes |
| 3245S0500X | Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | BH-1914 | AZ |
Practice location
1575 E Betsy Ln Unit DGilbert, AZ 85296-3759
Phone 623-474-6326 · Fax 623-474-6516
Mailing address
18403 W Verdin RdGoodyear, AZ 85338-5081
Phone 623-474-6326 · Fax 623-474-6516
Authorized official
Sherri Mckinney
Director
6234746326
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