1225140643 NPI number — PASADERA BEHAVIORAL HEALTH NETWORK, INC.

Table of content: (NPI 1225140643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225140643 NPI number — PASADERA BEHAVIORAL HEALTH NETWORK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PASADERA BEHAVIORAL HEALTH NETWORK, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DESERT HOPE INPATIENT SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225140643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 S 8TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85713-4730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-628-3400
Provider Business Mailing Address Fax Number:
520-628-3401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2499 E. AJO WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85713-6202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-618-8700
Provider Business Practice Location Address Fax Number:
520-327-9817
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVER
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF QUALITY MANAGEMENT OFFICER
Authorized Official Telephone Number:
520-628-3400

Provider Taxonomy Codes

  • Taxonomy code: 284300000X , with the licence number:  IFBH6554 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: IFBH6554 . This is a "STATE LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 807753 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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