Provider Demographics
NPI:1841431632
Name:HUMBLE HOUSE
Entity Type:Organization
Organization Name:HUMBLE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-937-3443
Mailing Address - Street 1:8572 W PALO VERDE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5354
Mailing Address - Country:US
Mailing Address - Phone:623-937-3443
Mailing Address - Fax:653-337-5523
Practice Address - Street 1:8572 W PALO VERDE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-5354
Practice Address - Country:US
Practice Address - Phone:623-937-3443
Practice Address - Fax:623-337-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3077322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children