Provider Demographics
NPI:1720670219
Name:THE WAY HOME BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:THE WAY HOME BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONLISK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-207-5144
Mailing Address - Street 1:12334 W ASTER DR
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-4202
Mailing Address - Country:US
Mailing Address - Phone:928-207-5144
Mailing Address - Fax:
Practice Address - Street 1:12334 W ASTER DR
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-4202
Practice Address - Country:US
Practice Address - Phone:928-207-5144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-06
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility