| Organization Name: | THE 12TH AVE HOUSE #1 |
| NPI Number: | 1013177666 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ELIZABETH SINGLETON (ADMINISTRATOR) |
| Mailing Address: | 9606 N 12th Ave Phoenix |
| State: | AZ US |
| Postal Code: | 850213095 |
| Phone Number: | 6024412691 |
| Fax Number: | |
| NPI Enumeration Date: | 06/16/2008 |
| NPI Last Update Date: | 06/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | BH - 3055 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |