Provider Demographics
NPI:1447842976
Name:FLOWING SPRING BEHAVIORAL HOME HEALTH
Entity type:Organization
Organization Name:FLOWING SPRING BEHAVIORAL HOME HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENEVE
Authorized Official - Middle Name:ATUH
Authorized Official - Last Name:TEBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-241-9586
Mailing Address - Street 1:1632 E LESLIE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-4077
Mailing Address - Country:US
Mailing Address - Phone:480-241-9586
Mailing Address - Fax:
Practice Address - Street 1:25284 N POSEIDON ROAD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132
Practice Address - Country:US
Practice Address - Phone:480-241-9586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness