Provider Demographics
NPI:1285966424
Name:CIMMARON ASH BEHAVIORAL HEALTHCARE
Entity type:Organization
Organization Name:CIMMARON ASH BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIYANA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BRUTUS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:480-694-2574
Mailing Address - Street 1:719 E COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2700
Mailing Address - Country:US
Mailing Address - Phone:520-858-0261
Mailing Address - Fax:520-858-0260
Practice Address - Street 1:719 E COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2700
Practice Address - Country:US
Practice Address - Phone:520-858-0261
Practice Address - Fax:520-858-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty