Provider Demographics
NPI:1891324711
Name:MINGUS MOUNTAIN ESTATE RESIDENCIAL CENTER, INC.
Entity Type:Organization
Organization Name:MINGUS MOUNTAIN ESTATE RESIDENCIAL CENTER, INC.
Other - Org Name:CASA GRANDE ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-340-4601
Mailing Address - Street 1:1120 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4206
Mailing Address - Country:US
Mailing Address - Phone:714-317-6552
Mailing Address - Fax:
Practice Address - Street 1:1120 E 6TH ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4206
Practice Address - Country:US
Practice Address - Phone:714-317-6552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINGUS MOUNTAIN ESTATE RESIDENCIAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-02
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children