Provider Demographics
NPI:1649998691
Name:AVRA VALLEY RELIANCE BEHAVIORAL HOME LLC
Entity type:Organization
Organization Name:AVRA VALLEY RELIANCE BEHAVIORAL HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMWITHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-624-4475
Mailing Address - Street 1:2162 W SPEEDWAY BLVD APT 31104
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-3938
Mailing Address - Country:US
Mailing Address - Phone:978-729-2869
Mailing Address - Fax:
Practice Address - Street 1:1621 N SILVERBELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-1816
Practice Address - Country:US
Practice Address - Phone:520-622-0488
Practice Address - Fax:520-889-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness