EAGLES NEST GROUP HOME, DBA (NPI# 1639596927) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639596927 |
| Entity Type | Organization |
| Organization Name | EAGLES NEST GROUP HOME, DBA |
| Other Organization Name | EAGLES NEST BOYS RESIDENTIAL AGENCY |
| Practice Address |
1802 E Dobbins Rd Phoenix AZ 85042-8500 |
| Practice Telephone | 6025681441 |
| Practice Fax Number | 6022684834 |
| Mailing Telephone | 6025681441 |
| Mailing Fax Number | 6022684834 |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2014-03-25 |
| Authorized Official Name | MR. TED D MCCLURE I (EXECUTIVE-DIRECTOR) |
| Authorized Official Telephone | 6025681441 |
| Authorized Official Credential | 6025681441 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | BH4442 | DC | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Eagles Nest Boys Residential Agency | Other Name - Individual/Organization |
| Street Address |
1802 E DOBBINS RD |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85042-8500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851937189 | Eagles Nest Eculid | Residential Treatment Facility, Emotionally Disturbed Children | 1802 E Dobbins Rd, Phoenix, AZ 85042-8500 | 2019-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306443197 | Da Homes LLC | Case Management | 8026 S. 24th Way, Phoenix, AZ 85042 | 2020-10-05 |
| 1144790460 | Ebony House Inc | Substance Abuse Rehabilitation Facility | 6222 S. 13th Street, Phoenix, AZ 85042 | 2018-11-29 |
| 1427538362 | Abigail Mcgrath | Dietitian, Registered | 303 E Baseline Rd Ste 200, Phoenix, AZ 85042 | 2018-08-20 |
| 1174028310 | Olufemi A Omodara | Pharmacist | 7227 S. Central Ave, #1080, Phoenix, AZ 85042 | 2018-03-29 |
| 1720537699 | Mary Youngblood | Registered Nurse | 7210 S 27th Way, Phoenix, AZ 85042 | 2016-10-03 |
| 1922490382 | Brian Zembower | Optometrist | 610 E Baseline Rd Ste C3, Phoenix, AZ 85042 | 2015-02-23 |
| 1417299819 | Robert Murphy Portley | Psychiatry & Neurology | 2320 E Baseline Rd Ste 148-225, Phoenix, AZ 85042 | 2013-03-23 |
| 1972807998 | Obinna Chukwuka Akubukwe | Pharmacist | 6006 S. Central Avenue, Phoenix, AZ 85042 | 2011-01-05 |
| 1104120328 | Gisheys Patient Care LLC | Custodial Care Facility | 7232 South 12th Place, Phoeniz, AZ 85042 | 2011-01-03 |
| 1245463488 | Lois Ann Hammitt | Registered Nurse | 6218 S. 7th Street, Phoenix, AZ 85042 | 2009-09-03 |
| Find all providers in zip 85042 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013558311 | Back To Life Incorporated | Residential Treatment Facility, Emotionally Disturbed Children | 6420 W Cocopah St, Phoenix, AZ 85043 | 2019-10-08 |
| 1881100147 | Anna Marie Barrios | Residential Treatment Facility, Emotionally Disturbed Children | 18811 N 7th Dr, Phoenix, AZ 85027-5508 | 2017-12-22 |
| 1023546819 | Zion Living | Residential Treatment Facility, Emotionally Disturbed Children | 1618 E Wood St, Phoenix, AZ 85040-1360 | 2017-05-24 |
| 1326400623 | Community Network Fellowship, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1839 N 39th St, Suite A, Phoenix, AZ 85008-3915 | 2016-03-25 |
| 1972910248 | Empower House LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2413 W Fetlock Trl, Phoenix, AZ 85085-5770 | 2014-07-17 |
| 1497032668 | Vision Group Home | Residential Treatment Facility, Emotionally Disturbed Children | 2917 W Bowker St, Phoenix, AZ 85041-3477 | 2011-11-15 |
| 1548544463 | Cdh Foundation | Residential Treatment Facility, Emotionally Disturbed Children | 4017 E La Puente Ave, Phoenix, AZ 85044-1339 | 2011-10-11 |
| 1760787527 | United Youth and Family Services | Residential Treatment Facility, Emotionally Disturbed Children | 33016 N 24th Ln, Phoenix, AZ 85085-6024 | 2011-01-25 |
| 1740500966 | Oasis Care Living, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 6434 S 17th Pl, Phoenix, AZ 85042-4554 | 2010-06-10 |
| 1619299054 | House of Hope | Residential Treatment Facility, Emotionally Disturbed Children | 5814 S 11th St, Phoenix, AZ 85040-3177 | 2010-02-26 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.