Provider Demographics
NPI:1558181412
Name:CYGNET ACADEMY LLC
Entity type:Organization
Organization Name:CYGNET ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-492-5270
Mailing Address - Street 1:711 E FLORENCE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4676
Mailing Address - Country:US
Mailing Address - Phone:480-604-5147
Mailing Address - Fax:625-294-7341
Practice Address - Street 1:711 E FLORENCE BLVD STE A
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4676
Practice Address - Country:US
Practice Address - Phone:480-604-5147
Practice Address - Fax:623-294-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty