Provider Demographics
NPI:1013244813
Name:GLENEAGLE MENTAL HEALTH AGENCIES INC
Entity Type:Organization
Organization Name:GLENEAGLE MENTAL HEALTH AGENCIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-988-9929
Mailing Address - Street 1:20348 E WARNER RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-9655
Mailing Address - Country:US
Mailing Address - Phone:480-988-9929
Mailing Address - Fax:480-279-3828
Practice Address - Street 1:20348 E WARNER RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-9655
Practice Address - Country:US
Practice Address - Phone:480-988-9929
Practice Address - Fax:480-279-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH 3402251S00000X, 261QR0800X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care