Provider Demographics
NPI:1326481193
Name:BURTON HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:BURTON HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HOMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-382-1207
Mailing Address - Street 1:12312 W DELWOOD DR
Mailing Address - Street 2:PO BOX 3699
Mailing Address - City:ARIZONA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85123
Mailing Address - Country:US
Mailing Address - Phone:505-383-1207
Mailing Address - Fax:
Practice Address - Street 1:12312 W DELWOOD DR
Practice Address - Street 2:
Practice Address - City:ARIZONA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85123
Practice Address - Country:US
Practice Address - Phone:505-383-1207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0000000OtherNONE
AZ000000OtherAHCCCS