MEDICARE: SAMHC ENTERPRISES LLC DBA ELANTE COUNSELING 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	OTC6596	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	OTC6596	OTHER	AZ	STATE LICENSE

General Provider Information

NPI Number	:	1235412867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMHC ENTERPRISES LLC DBA ELANTE COUNSELING CENTER

Provider Business Mailing Address
First Line	:	2700 S 8TH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-4730
Country	:	US
Telephone Number	:	520-628-3400
Fax Number	:	520-628-3401

Provider Business Practice Location Address
First Line	:	6280 E PIMA ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3074
Country	:	US
Telephone Number	:	520-722-9155
Fax Number	:	520-722-0500

Authorized Official
Title or Position	:	CHIEF QUALITY MANAGEMENT OFFICER
Name	:	STEPHANIE OLIVER
Credential	:	CPC, RMM, ICD10CT-CM
Telephone Number	:	520-628-3400

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	08/13/2015

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