EASTER SEALS BLAKE FOUNDATION (NPI# 1194156125) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194156125 |
| Entity Type | Organization |
| Organization Name | EASTER SEALS BLAKE FOUNDATION |
| Other Organization Name | KACHINA HOUSE |
| Practice Address |
5626 E 2nd St Tucson AZ 85711-1415 |
| Mailing Address |
7750 E Broadway Blvd Tucson AZ 85710-3901 |
| Practice Telephone | 5207508249 |
| Mailing Telephone | 5203271529 |
| Mailing Fax Number | 5203271836 |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2014-06-18 |
| Authorized Official Name | MS. EMA KAMMEYER (C.E.O.) |
| Authorized Official Telephone | 5203271529 |
| Authorized Official Credential | J.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | BH-4425 | AZ | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | AHCCCS PROVIDER | 881527 | 01 |
| AZ | AZ BEHAVIORAL HEALTH RESIDENTIAL FACILITY LICENSE | BH4425 | 01 |
| Other Name | Type Code |
|---|---|
| Kachina House | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053828160 | Easter Seals Blake Foundation | Community/Behavioral Health | 618 South Central Avenue, Safford, AZ 85546 | 2018-01-10 |
| 1548781487 | Easter Seals Blake Foundation | Community/Behavioral Health | 7750 E Broadway Blvd Ste A100, Tucson, AZ 85710-3901 | 2017-06-30 |
| 1376967323 | Easter Seals Blake Foundation | Community/Behavioral Health | 1060 S 5th Ave, Yuma, AZ 85364-3823 | 2014-02-11 |
| 1932530797 | Easter Seals Blake Foundation | Community/Behavioral Health | 7756 E Broadway Blvd, Ste. A-100, Tucson, AZ 85710 | 2013-12-04 |
| 1679847834 | Easter Seals Blake Foundation | Community/Behavioral Health | 320 S Convent Ave, Tucson, AZ 85701-2215 | 2012-03-05 |
| 1104079714 | Easter Seals Blake Foundation | Community/Behavioral Health | 1938 W Thatcher Blvd, Safford, AZ 85546-3318 | 2008-10-28 |
| 1548356207 | Easter Seals Blake Foundation | Case Management | 5704 E. Grant Road, Tucson, AZ 85712 | 2006-10-04 |
| 1760906440 | Easter Seals Blake Foundation | Counselor | 310 S Meyer Ave, Tucson, AZ 85701-2207 | 2017-08-03 |
| 1164875969 | Easter Seals Blake Foundation | Clinic/Center | 288 N Ironwood Dr Ste 115, Apache Junction, AZ 85120-3830 | 2016-07-15 |
| 1821429853 | Easter Seals Blake Foundation | Residential Treatment Facility, Emotionally Disturbed Children | 5752 E Waverly St, Tucson, AZ 85712-3739 | 2013-12-02 |
| Street Address |
5626 E 2ND ST |
| City | TUCSON |
| State | AZ |
| Zip Code | 85711-1415 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548319890 | Supported Living Systems | Residential Treatment Facility, Emotionally Disturbed Children | 5626 E 2nd St, Tucson, AZ 85711-1415 | 2007-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356959951 | Ridgeline Practice | Counselor | 4625 N Broadway, Suite 105, Tucson, AZ 85711 | 2020-07-20 |
| 1881229946 | Famiglia Amore II LLC | Assisted Living Facility | 632 N. Wilmot, Tucson, AZ 85711 | 2020-03-10 |
| 1992343362 | Laurie Anne Mcmahon | Family Medicine | 899 N. Wilmot, Building B, Tucson, AZ 85711 | 2019-12-17 |
| 1063060093 | Sharese Ann Bailey | Counselor | 300 S Craycroft Rd, Tucson, AZ 85711 | 2019-09-03 |
| 1467940015 | Jin Zhang | Ophthalmology | 655 N Alvernon Way Ste 204, Tucson, AZ 85711 | 2018-04-30 |
| 1447779525 | Catherine Butler Hobart | Pharmacist | 535 North Wilmont Road, Suite 101, Tucson, AZ 85711 | 2017-09-11 |
| 1689196420 | Cope Community Services, Inc. | Case Management | 924 N Alvernon Way, Tucson, AZ 85711 | 2017-07-13 |
| 1124561477 | Regina Maendler | Behavioral Analyst | 630 N. Craycroft Rd, Tucson, AZ 85711 | 2016-11-18 |
| 1881140184 | Elleda Linsmeyer | Speech-Language Pathologist | St. Joesph's Hosptial, 350 N. Wilmont Rd., Tucson, AZ 85711 | 2016-08-28 |
| 1962856260 | Csl-tucson, LLC | Assisted Living Facility | 1020 N. Woodland Avenue, Tucson, AZ 85711 | 2016-04-22 |
| Find all providers in zip 85711 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033756358 | Native Music Coalition | Residential Treatment Facility, Emotionally Disturbed Children | 5150 S Crazy Cat Ln, Tucson, AZ 85735 | 2019-12-05 |
| 1538668983 | Starks Homes LLC | Residential Treatment Facility, Emotionally Disturbed Children | 7325 E Fayette St, Tucson, AZ 85730-2324 | 2018-02-12 |
| 1417349028 | Intermountain Centers for Human Develoment Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 8851 East Tanque Verde, Tucson, AZ 85749 | 2015-02-19 |
| 1063749521 | Casa De Tucson LLC | Residential Treatment Facility, Emotionally Disturbed Children | 5055 W Pima Farms Rd, Tucson, AZ 85741-4736 | 2009-11-04 |
| 1417128950 | New Beginnings Treatment Center, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 2937 N Stone Ave, Tucson, AZ 85705-5915 | 2008-03-12 |
| 1417134933 | Intermountain Centers for Human Development Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1310 N Speedway Pl, Tucson, AZ 85715-5236 | 2008-01-28 |
| 1518142033 | La Paloma Family Services | Residential Treatment Facility, Emotionally Disturbed Children | 870 W Miracle Mile Bldg 2, Tucson, AZ 85705-3708 | 2008-01-03 |
| 1538341458 | New Beginnings Treatment Center, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 2445 N Oracle Rd, Tucson, AZ 85705-4321 | 2007-12-03 |
| 1467661470 | Pascua Yaqui Tribe | Residential Treatment Facility, Emotionally Disturbed Children | 2861 W Via Hacienda, Tucson, AZ 85741-3424 | 2007-05-22 |
| 1477766723 | La Paloma Family Services | Residential Treatment Facility, Emotionally Disturbed Children | 1718 N Mckinley Ave, Tucson, AZ 85712-3726 | 2007-05-07 |
| Find all providers in TUCSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.