Provider Demographics
NPI:1356802912
Name:TALAS HARBOR AT BULLHEAD CITY
Entity type:Organization
Organization Name:TALAS HARBOR AT BULLHEAD CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-241-4992
Mailing Address - Street 1:831 LANDON DRIVE
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86429
Mailing Address - Country:US
Mailing Address - Phone:800-336-5689
Mailing Address - Fax:
Practice Address - Street 1:831 LANDON DRIVE
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86429
Practice Address - Country:US
Practice Address - Phone:800-336-5689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital