1609229574 NPI number — PASADERA BEHAVIORAL HEALTH NETWORK, INC.

Table of content: (NPI 1609229574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609229574 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:
Provider Other Organization Name Type Code:
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:
1609229574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2016
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:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2502 N DODGE BLVD STE 190
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:
85716-2675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-628-3400
Provider Business Practice Location Address Fax Number:
520-628-3151
Provider Enumeration Date:
07/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CANCHOLA
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CONTRACTS, COMPLIANCE MANAGER
Authorized Official Telephone Number:
520-628-3450

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  BH-4798 , 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)





Copyright © 2007-2025 www.npivalidator.com