| Organization Name: | TYERRA MANOR, LLC RESIDENTIAL AGENCY |
| NPI Number: | 1164673760 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SAFFIE S. TUNIS (CO-CEO/PROGRAM DIRECTOR) |
| Mailing Address: | 1533 E Sunland Ave Phoenix |
| State: | AZ US |
| Postal Code: | 850403269 |
| Phone Number: | 6022682538 |
| Fax Number: | 6022682538 |
| NPI Enumeration Date: | 10/02/2008 |
| NPI Last Update Date: | 11/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | BH-3122 |
| 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. |