Provider Demographics
NPI:1588401079
Name:AT PEACE 2
Entity type:Organization
Organization Name:AT PEACE 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASLI
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-890-6047
Mailing Address - Street 1:18338 W COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-3009
Mailing Address - Country:US
Mailing Address - Phone:310-901-7807
Mailing Address - Fax:
Practice Address - Street 1:19209 W PASADENA AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5721
Practice Address - Country:US
Practice Address - Phone:310-901-7807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AT PEACE BEHAVIOR MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness