1346255908 NPI number — SOUTHWEST BEHAVIORAL HEALTH

Table of content: (NPI 1346255908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346255908 NPI number — SOUTHWEST BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST BEHAVIORAL HEALTH
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:
1346255908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3450 N 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85012-2331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-257-9339
Provider Business Mailing Address Fax Number:
602-265-8574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4015 S 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85040-1134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-243-0049
Provider Business Practice Location Address Fax Number:
302-243-7291
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JORDE
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
602-285-4285

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  BH-051 , 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: 768228 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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