Provider Demographics
NPI:1427656065
Name:CHINLE ADULT RESIDENTIAL TREATMENT
Entity type:Organization
Organization Name:CHINLE ADULT RESIDENTIAL TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLATCHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:928-674-2190
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-0777
Mailing Address - Country:US
Mailing Address - Phone:928-674-2190
Mailing Address - Fax:928-674-2191
Practice Address - Street 1:NAVAJO ROUTE 7, DUPLEX UNIT 2004
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-2190
Practice Address - Fax:928-674-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility