Provider Demographics
NPI:1790166072
Name:HOME AWAY FROM HOME BEHAVIORAL HEALTH RESIDENTIAL FACILITY INC.
Entity Type:Organization
Organization Name:HOME AWAY FROM HOME BEHAVIORAL HEALTH RESIDENTIAL FACILITY INC.
Other - Org Name:HOME AWAY FROM HOME BEHAVIORAL HEALTH RESIDENTIAL
Other - Org Type:Doing Business As
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:PO BOX 7077
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-0635
Mailing Address - Country:US
Mailing Address - Phone:602-559-6033
Mailing Address - Fax:623-322-8622
Practice Address - Street 1:9231 W MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-4306
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:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4584322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children