Provider Demographics
NPI:1881924736
Name:HACIENDA DE CONTENIDO, INC
Entity type:Organization
Organization Name:HACIENDA DE CONTENIDO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:928-830-2222
Mailing Address - Street 1:520 N SYCAMORE VISTA DIVE
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323
Mailing Address - Country:US
Mailing Address - Phone:928-830-2222
Mailing Address - Fax:928-583-0376
Practice Address - Street 1:520 SYCAMORE VISTA DR
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5842
Practice Address - Country:US
Practice Address - Phone:928-830-2222
Practice Address - Fax:928-583-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLBSW0290251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health