Provider Demographics
NPI:1710374442
Name:LOOKING FORWARD BEHAVIORAL HEALTH RESIDENTIAL FACILITY INC.
Entity Type:Organization
Organization Name:LOOKING FORWARD BEHAVIORAL HEALTH RESIDENTIAL FACILITY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:MARGUERITE
Authorized Official - Last Name:AYIYI
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:602-559-6033
Mailing Address - Street 1:6202 W OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-6632
Mailing Address - Country:US
Mailing Address - Phone:602-559-6033
Mailing Address - Fax:623-322-8622
Practice Address - Street 1:6202 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-6632
Practice Address - Country:US
Practice Address - Phone:602-559-6033
Practice Address - Fax:623-322-8622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4513322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children