Provider Demographics
NPI:1235736018
Name:HAPPY VALLEY COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:HAPPY VALLEY COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TYUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-236-3282
Mailing Address - Street 1:1106 E COCHISE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-1550
Mailing Address - Country:US
Mailing Address - Phone:612-236-3282
Mailing Address - Fax:
Practice Address - Street 1:1106 E COCHISE DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-1550
Practice Address - Country:US
Practice Address - Phone:612-236-3282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness