Provider Demographics
NPI:1346869039
Name:WESTCARE ARIZONA I, INC.
Entity Type:Organization
Organization Name:WESTCARE ARIZONA I, INC.
Other - Org Name:HILDY'S HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-385-2090
Mailing Address - Street 1:PO BOX 94738
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-4738
Mailing Address - Country:US
Mailing Address - Phone:702-385-2090
Mailing Address - Fax:702-924-2575
Practice Address - Street 1:1160 AGATE RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-763-1945
Practice Address - Fax:928-763-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility