Provider Demographics
NPI:1417345273
Name:TURTLE BAY CAFE OF CASA GRANDE, LLC
Entity Type:Organization
Organization Name:TURTLE BAY CAFE OF CASA GRANDE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-369-0075
Mailing Address - Street 1:1340 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4626
Mailing Address - Country:US
Mailing Address - Phone:602-369-0075
Mailing Address - Fax:
Practice Address - Street 1:109 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5212
Practice Address - Country:US
Practice Address - Phone:602-369-0075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO RIVER BEHAVIORAL HEALTH SYSTEM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-02
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health