Provider Demographics
NPI:1013317106
Name:AAA HEALTH AND SAFETY LODGE
Entity Type:Organization
Organization Name:AAA HEALTH AND SAFETY LODGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:BAYEMAKE
Authorized Official - Last Name:MAHOP
Authorized Official - Suffix:
Authorized Official - Credentials:MAS
Authorized Official - Phone:817-704-9973
Mailing Address - Street 1:7227 FOSSIL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4711
Mailing Address - Country:US
Mailing Address - Phone:817-704-9973
Mailing Address - Fax:
Practice Address - Street 1:7227 FOSSIL LAKE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4711
Practice Address - Country:US
Practice Address - Phone:817-704-9973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness