Basic Information
| Provider Information | |||||||||
| NPI: | 1639491681 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THREE SPRINGS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1131 EAGLE TREE LANE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568803339 | ||||||||
| FaxNumber: | 2568809569 | ||||||||
| Practice Location | |||||||||
| Address1: | EAST HWY 163 KMPH#81 | ||||||||
| Address2: | |||||||||
| City: | KAYENTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286973154 | ||||||||
| FaxNumber: | 9286743156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2010 | ||||||||
| LastUpdateDate: | 02/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | BALCH | ||||||||
| AuthorizedOfficialFirstName: | BROOKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BOARD OF MANAGERS | ||||||||
| AuthorizedOfficialTelephone: | 2568803339 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.