1972980522 NPI number — PRS NEUROHEALTH SOLUTIONS, LLC

Table of content: (NPI 1972980522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972980522 NPI number — PRS NEUROHEALTH SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRS NEUROHEALTH SOLUTIONS, 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:
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:
1972980522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17470 N PACESETTER WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85255-5445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-696-5796
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 E RIO SALADO PKWY
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85281-9124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-696-5796
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SOUTHLAND
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
OWEN
Authorized Official Title or Position:
DIRECTOR OF RESEARCH & TECHNOLOGY
Authorized Official Telephone Number:
480-696-5796

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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