Provider Demographics
NPI:1629354493
Name:PRATS RESIDENTIAL BEHAVIORAL HEALTH AGENCY III
Entity Type:Organization
Organization Name:PRATS RESIDENTIAL BEHAVIORAL HEALTH AGENCY III
Other - Org Name:DINE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GISELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:602-348-2115
Mailing Address - Street 1:3015 E GELDING DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5032
Mailing Address - Country:US
Mailing Address - Phone:602-348-2115
Mailing Address - Fax:602-996-1577
Practice Address - Street 1:3014 E EMILE ZOLA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-6049
Practice Address - Country:US
Practice Address - Phone:602-348-2115
Practice Address - Fax:602-996-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3963320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness