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General NPI Number Information
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NPI Number | 1619202074
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Entity Type | Organization
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Legal Business Name | AMERICAN EAGLE BEHAVIORAL HEALTH AGENCY
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Dates
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Enumeration Date | 10/02/2009
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Last Update Date | 10/02/2009
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Provider Practice Location Address
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Address Line | 3536 W VENUS DR
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City | SOMERTON
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State | AZ
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Zip | 85350-7245
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Country | US
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Telephone | 928-271-5550
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 S 5TH AVE
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City | YUMA
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State | AZ
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Zip | 85364-4607
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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
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Name | ADAM HANSEN
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Credential |
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Telephone | 926-271-5550
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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 | BH-3409
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License Number State | AZ
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