Provider Demographics
NPI:1962703991
Name:PRESCOTT HOUSE INC
Entity type:Organization
Organization Name:PRESCOTT HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIR.
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:DAYTON
Authorized Official - Last Name:TURBERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-776-8251
Mailing Address - Street 1:214 N. AZ AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:928-776-8251
Mailing Address - Fax:928-771-2024
Practice Address - Street 1:214 N. AZ AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-776-8251
Practice Address - Fax:928-771-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-264320800000X, 324500000X
AZOTC-6470320800000X
AZBH-4262324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness