EAGLEDANCER YOUTH AND FAMILY SERVICES, INC. (NPI# 1730375668) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730375668 |
| Entity Type | Organization |
| Organization Name | EAGLEDANCER YOUTH AND FAMILY SERVICES, INC. |
| Practice Address |
305 West Ben Gay White River AZ 85941 |
| Mailing Address |
1323 Lobo Trl 1323 Lobo Trail Snowflake AZ 85937-5407 |
| Practice Telephone | 9283382312 |
| Practice Fax Number | 9283382313 |
| Mailing Telephone | 9282273950 |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2011-03-15 |
| Authorized Official Name | MRS. CHARLA C HATCH (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9282290560 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320800000X | Community Based Residential Treatment Facility, Mental Illness | AZ | Residential Treatment Facilities | |
| N | 324500000X | Substance Abuse Rehabilitation Facility | AZ | Residential Treatment Facilities | |
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | AZ | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 263967 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811295942 | Eagledancer Youth and Family Services, Inc. | Foster Care Agency | 1323 Lobo Trl, Snowflake, AZ 85937-5407 | 2011-03-15 |
| Street Address |
305 WEST BEN GAY |
| City | WHITE RIVER |
| State | AZ |
| Zip Code | 85941 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649816778 | Benjamin Robert Bishop | Pharmacist | 200 W Hospital Road, Whiteriver, AZ 85941 | 2019-11-25 |
| 1750922308 | Christal A Brewer | Specialist/Technologist | 1 N 1st Ave, Whiteriver, AZ 85941 | 2019-10-04 |
| 1154880862 | Ivan Atole IIi | Counselor | 302 W Ponderosa St, Whiteriver, AZ 85941 | 2019-03-13 |
| 1912456732 | Jamie Baha | Counselor | 302 West Ponderosa Street, White River, AZ 85941 | 2016-09-22 |
| 1891243382 | Donna Mauree Stevens | Counselor | 302 W. Ponderosa St., Whiteriver, AZ 85941 | 2016-09-14 |
| 1811445307 | Aura Josefina Ortiz | Counselor | 302 W Ponderosa Street, Whiteriver, AZ 85941 | 2016-09-14 |
| 1891152567 | White Mountain Apache Tribe Fire and Rescue | Ambulance | 612 S. Chief Ave, Whiteriver, AZ 85941 | 2016-01-26 |
| 1528450855 | Carla Francis Turrentine | Social Worker | 249 West Ponderosa Street, Whiteriver, AZ 85941 | 2015-02-24 |
| 1477890390 | Muhammad Kanakri | Pharmacist | 200 West Whiteriver, Usphs Indian Hospital, Whitriver, AZ 85941 | 2013-01-11 |
| 1871870980 | Kathleen Wynn | Registered Nurse | 400 Apache Drive, Whiteriver, AZ 85941 | 2011-11-03 |
| Find all providers in zip 85941 | ||||
| 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 |
|---|---|---|---|---|
| 1528666039 | Rehoboth LLC | Residential Treatment Facility, Emotionally Disturbed Children | 46136 W Mountain View Rd # A, Maricopa, AZ 85139-6796 | 2020-10-16 |
| 1962022665 | New Hope of Arizona, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 8710 W Watkins St, Tolleson, AZ 85353-9028 | 2020-04-22 |
| 1639798143 | Anthony Udoinwang | Residential Treatment Facility, Emotionally Disturbed Children | 10435 W Reade Ave, Glendale, AZ 85307-4237 | 2020-04-14 |
| 1033756358 | Native Music Coalition | Residential Treatment Facility, Emotionally Disturbed Children | 5150 S Crazy Cat Ln, Tucson, AZ 85735 | 2019-12-05 |
| 1013558311 | Back To Life Incorporated | Residential Treatment Facility, Emotionally Disturbed Children | 6420 W Cocopah St, Phoenix, AZ 85043 | 2019-10-08 |
| 1487118865 | Serenity Preferred LLC | Residential Treatment Facility, Emotionally Disturbed Children | 17829 W Columbine Dr, Surprise, AZ 85388-5628 | 2019-01-30 |
| 1407333958 | Copa's Caring Hands LLC. | Residential Treatment Facility, Emotionally Disturbed Children | 42251 W Bravo Dr, Maricopa, AZ 85138-2295 | 2018-07-26 |
| 1538668983 | Starks Homes LLC | Residential Treatment Facility, Emotionally Disturbed Children | 7325 E Fayette St, Tucson, AZ 85730-2324 | 2018-02-12 |
| 1881100147 | Anna Marie Barrios | Residential Treatment Facility, Emotionally Disturbed Children | 18811 N 7th Dr, Phoenix, AZ 85027-5508 | 2017-12-22 |
| 1033625926 | Youth Transition Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1190 S Boulder St Unit D, Gilbert, AZ 85296-3792 | 2017-12-14 |
| Find all providers with the same taxonomy | ||||
| City | WHITE RIVER |
| Zip Code | 85941 |
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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.