Provider Demographics
NPI:1649965195
Name:EAGLES NEST THUNDERBIRD LLC
Entity type:Organization
Organization Name:EAGLES NEST THUNDERBIRD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COBBS-MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-570-9309
Mailing Address - Street 1:1802 E DOBBINS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-8500
Mailing Address - Country:US
Mailing Address - Phone:602-568-1441
Mailing Address - Fax:602-268-4834
Practice Address - Street 1:540 E THUNDERBIRD TRL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-8370
Practice Address - Country:US
Practice Address - Phone:602-305-9599
Practice Address - Fax:602-268-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children