Provider Demographics
NPI:1184087223
Name:EMMARIE BEHAVIORAL HOME CARE. LLC
Entity type:Organization
Organization Name:EMMARIE BEHAVIORAL HOME CARE. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:ADE
Authorized Official - Last Name:EPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-481-9789
Mailing Address - Street 1:1638 E GREENWAY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5788
Mailing Address - Country:US
Mailing Address - Phone:602-237-8045
Mailing Address - Fax:602-237-9975
Practice Address - Street 1:5748 W HIDALGO AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-5157
Practice Address - Country:US
Practice Address - Phone:602-237-8045
Practice Address - Fax:602-237-9975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMMARIE BEHAVIORAL HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4831323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility