Organization Name: | WEST YAVAPAI GUIDANCE CLINIC, INC. |
NPI Number: | 1033163514 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LARRY D GREEN (CHIEF EXECUTIVE OFFICER) |
Mailing Address: | 711 Hillside Ave Prescott |
State: | AZ US |
Postal Code: | 86301 |
Phone Number: | 9284455211 |
Fax Number: | 9287171204 |
NPI Enumeration Date: | 05/20/2006 |
NPI Last Update Date: | 07/10/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320600000X |
License Number: | BH1394 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |