EASTER SEALS BLAKE FOUNDATION NPI 1548691454

NPI Information

NPI: 1548691454
Provider Name: EASTER SEALS BLAKE FOUNDATION

Other Name: AGAPE HOUSE

Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
Address:
4454 E 3RD ST
TUCSON, AZ
ZIP 85711
Phone: (520) 881-3090
Get Directions

EASTER SEALS BLAKE FOUNDATION is a community based residential treatment facility mental illness in Tucson, AZ. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. EASTER SEALS BLAKE FOUNDATION NPI is 1548691454. The provider is registered as an organization entity type.
The provider Other Name Is Agape House.

The provider's business location address is:

4454 E 3RD ST
TUCSON, AZ
ZIP 85711-189
Phone: (520) 881-3090

The provider's authorized official is Marissa S Arendt .
The authorized official title is Cfo and has the following contact phone number (520) 327-1529.

The enumeration date for this NPI number is 12/2/2013 and was last updated on 8/3/2021.

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	320800000X	Community Based Residential Treatment Facility, Mental Illness		BH-4429	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	881725	OTHER	ARIZONA	AHCCCS PROVIDER
2	BH4429	OTHER	ARIZONA	AZ BEHAVIORAL HEALTH RESIDENTIAL FACILITY LICENSE

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: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »