1366154379 NPI number — AKDHC, LLC

Table of content: (NPI 1366154379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366154379 NPI number — AKDHC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AKDHC, LLC
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:
6
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:
1366154379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 E CAMELBACK RD STE 180
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:
85018-2396
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-759-6883
Provider Business Mailing Address Fax Number:
602-224-3358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 N LA CANADA DR STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREEN VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85614-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-585-4590
Provider Business Practice Location Address Fax Number:
520-398-7540
Provider Enumeration Date:
12/21/2022

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHYSICIAN SERVICES
Authorized Official Telephone Number:
602-997-0484

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 244929 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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