Provider Demographics
NPI:1023608247
Name:AT PEACE BEHAVIOR MANAGEMENT
Entity type:Organization
Organization Name:AT PEACE BEHAVIOR MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASLI
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARUUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-890-6047
Mailing Address - Street 1:7330 W ST CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7012
Mailing Address - Country:US
Mailing Address - Phone:602-599-4309
Mailing Address - Fax:
Practice Address - Street 1:7330 W ST CHARLES AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7012
Practice Address - Country:US
Practice Address - Phone:602-599-4309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty