EUREKA IMPERIAL RESIDENCE NPI 1649798752

NPI Information

NPI: 1649798752
Provider Name: EUREKA IMPERIAL RESIDENCE

Doing Business As: CHANGING LIVES OUTPATIENT CENTER

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
633 E RAY ROAD
GILBERT, AZ
ZIP 85295
Phone: (480) 264-2647
Get Directions

EUREKA IMPERIAL RESIDENCE is a mental health (including community mental health center) clinic center in Gilbert, AZ. EUREKA IMPERIAL RESIDENCE NPI is 1649798752. The provider is registered as an organization entity type.
The provider Is Doing Business As Changing Lives Outpatient Center.

The provider's business location address is:

633 E RAY ROAD
GILBERT, AZ
ZIP 85295
Phone: (480) 264-2647

The provider's authorized official is Cornelius Tanyi .
The authorized official title is Program Director and has the following contact phone number (480) 264-2647.

The enumeration date for this NPI number is 9/8/2017 and was last updated on 9/8/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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