Provider Demographics
NPI:1578978409
Name:EMMARIE BEHAVIORAL HOME CARE
Entity Type:Organization
Organization Name:EMMARIE BEHAVIORAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:ADE
Authorized Official - Last Name:EPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-481-9789
Mailing Address - Street 1:1638 E GREENWAY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5788
Mailing Address - Country:US
Mailing Address - Phone:602-481-9789
Mailing Address - Fax:602-268-1248
Practice Address - Street 1:2926 W WAYLAND DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-4436
Practice Address - Country:US
Practice Address - Phone:602-276-2204
Practice Address - Fax:602-268-1248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMMARIE BEHAVIORAL HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3103320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness