Provider Demographics
NPI:1801289178
Name:EMMARIE BEHAVIORAL HOME CARE
Entity type:Organization
Organization Name:EMMARIE BEHAVIORAL HOME CARE
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:602-441-2561
Mailing Address - Fax:602-374-8639
Practice Address - Street 1:3031 W BURGESS LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6201
Practice Address - Country:US
Practice Address - Phone:602-441-2561
Practice Address - Fax:602-374-8639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4564320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities