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KELLY MEGAHAN

>> Community Based Residential Treatment Facility, Mental Illness >> Residential Treatment Facilities

Registrant NPI Number: 1346660602

Individual Registrant:
 KELLY  MEGAHAN 
Gender: F
Sole Proprietor

Location and contact information for practice:
3011 S SYCAMORE CANYON DRIVE  PARKS, AZ 86018-0304 US
Tel: 928-853-4152  Fax: --

Contact information for business:
PO BOX 50304  PARKS, AZ 86018-0304 US
Tel: 928-853-4152  Fax: --

Registration Information:
NPI: 1346660602
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y320800000XResidential Treatment Facilities
Community Based Residential Treatment Facility, Mental Illness
AZ3092313

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




HEALTH CARE JOBS AZ - Page 1



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