| Organization Name: | MINGUS MOUNTAIN ESTATE RESIDENTIAL CENTER INC |
| NPI Number: | 1114090925 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRIS BANKEN (EXECUTIVE DIRECTOR) |
| Mailing Address: | 100 Dewey Road Farrington Home Dewey |
| State: | AZ US |
| Postal Code: | 86327 |
| Phone Number: | 6023352095 |
| Fax Number: | 6022491311 |
| NPI Enumeration Date: | 11/17/2006 |
| NPI Last Update Date: | 07/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3104A0630X |
| License Number: | BH-1122 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Assisted Living Facility |
| Taxonomy Specialization: | Assisted Living, Behavioral Disturbances |
| Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors. |