Provider Demographics
NPI:1396550679
Name:AVRA VALLEY RELIANCE BEHAVIORAL HOME LLC
Entity type:Organization
Organization Name:AVRA VALLEY RELIANCE BEHAVIORAL HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMWITHI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:978-729-2869
Mailing Address - Street 1:2010 W GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1108
Mailing Address - Country:US
Mailing Address - Phone:520-624-4475
Mailing Address - Fax:520-882-4536
Practice Address - Street 1:1304 W SONORA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-3140
Practice Address - Country:US
Practice Address - Phone:520-207-1884
Practice Address - Fax:520-207-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness