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General NPI Number Information
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NPI Number | 1992120885
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Entity Type | Organization
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Legal Business Name | ANIMALS FACILITATING ADOLESCENTS AND CHILDREN THERAPEUTICALLY, INC.
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Dates
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Enumeration Date | 02/28/2014
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Last Update Date | 02/28/2014
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Provider Practice Location Address
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Address Line | 39213 S WILD HARDT WAY STE A
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City | MARANA
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State | AZ
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Zip | 85658-8396
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Country | US
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Telephone | 520-400-9444
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Fax | 520-879-6180
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Provider Business Mailing Address
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Address Line | 39213 S WILD HARDT WAY STE A
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City | MARANA
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State | AZ
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Zip | 85658-8396
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Country | US
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Telephone | 520-400-9444
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Fax | 520-879-6180
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. DORI SUZAN TAMAGNI
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Credential | LCSW, LISAC
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Telephone | 520-400-9444
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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-4395
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License Number State | AZ
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