MEDICARE: EMPACT - SUICIDE PREVENTION CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1215311378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPACT - SUICIDE PREVENTION CENTER

Provider Business Mailing Address
First Line	:	618 S MADISON DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85281-7248
Country	:	US
Telephone Number	:	480-784-1514
Fax Number	:

Provider Business Practice Location Address
First Line	:	2474 E HUNT HWY STE 100
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-5210
Country	:	US
Telephone Number	:	480-784-1514
Fax Number	:	480-967-3528

Authorized Official
Title or Position	:	REGIONAL VICE PRESIDENT
Name	:	ERICA CHESTNUT-RAMIREZ
Credential	:
Telephone Number	:	480-868-9479

Provider Enumeration Date	:	07/17/2015
Last Update Date	:	07/28/2025

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