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General NPI Number Information
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NPI Number | 1538681374
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Entity Type | Organization
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Legal Business Name | REY ASH RESIDENTIAL FACILITY LLC
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 07/13/2017
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Provider Practice Location Address
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Address Line | 3765 W YELLOW PEAK DR
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85142-3090
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Country | US
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Telephone | 602-214-2279
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Fax |
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Provider Business Mailing Address
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Address Line | 3765 W YELLOW PEAK DR
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85142-3090
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MR. EMMANUEL ASHIAGBOR
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Credential |
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Telephone | 602-214-2279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | BH5210
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License Number State |
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