Organization · Type 2 NPI

Eureka Imperial Residence

Mental Health Clinic/Center (Including Community Mental Health Center) · Gilbert, AZ

NPI number 1649798752 Active

Practice location

633 E Ray Road
Gilbert, AZ 85295

Call (480) 264-2647 Map

Mailing address

633 E Ray Rd
Gilbert, AZ 85296-4200

Specialties and licenses

Taxonomy	Code	License
Mental Health Clinic/Center (Including Community Mental Health Center) Primary	261QM0801X	None listed

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NPI record

NPI: 1649798752
Entity type: Organization (Type 2)
Issued: Sep 8, 2017
Last updated: Sep 8, 2017
Status: Active
Subpart: Yes of Eureka Imperial Residence

Other names

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Changing Lives Outpatient Center · doing business as

Authorized official

Cornelius Tanyi
Program Director
(480) 264-2647

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1649798752

Eureka Imperial Residence's National Provider Identifier is 1649798752, issued on Sep 8, 2017. The primary taxonomy on file is Mental Health Clinic/Center (Including Community Mental Health Center) (261QM0801X), and the practice location is in Gilbert, AZ. The record was last updated on Sep 8, 2017.