Provider Demographics
NPI:1073055737
Name:BABETZ, ELENA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:BABETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22432 N 80TH LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2149
Mailing Address - Country:US
Mailing Address - Phone:623-203-4708
Mailing Address - Fax:623-321-6888
Practice Address - Street 1:22432 N 80TH LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2149
Practice Address - Country:US
Practice Address - Phone:623-203-4708
Practice Address - Fax:623-321-6888
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-12
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness