| Tri-phase Group Home Inc | |
|
1575 E Betsy Ln Unit D Gilbert AZ 85296-3759 | |
| (623) 474-6326 | |
| (623) 474-6516 |
| Full Name | Tri-phase Group Home Inc |
|---|---|
| Speciality | Counselor |
| Location | 1575 E Betsy Ln Unit D, Gilbert, Arizona |
| Authorized Official Name and Position | Sherri Mckinney (DIRECTOR) |
| Authorized Official Contact | 6234746326 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri-phase Group Home Inc 18403 W Verdin Rd Goodyear AZ 85338-5081 Ph: (623) 474-6326 | Tri-phase Group Home Inc 1575 E Betsy Ln Unit D Gilbert AZ 85296-3759 Ph: (623) 474-6326 |
| NPI Number | 1396914735 |
|---|---|
| Provider Enumeration Date | 02/28/2008 |
| Last Update Date | 06/26/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396914735 | NPI | - | NPPES |
| 873770 | Other | AZ | AHCCCS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | BH-1914 (Arizona) | Primary |
| 3245S0500X | Substance Abuse Rehabilitation Facility - Substance Abuse Treatment, Children | BH-1914 (Arizona) | Secondary |
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