MEDICARE: SOUTHWEST BEHAVIORAL HEALTH SERVICES

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	323P00000X	Psychiatric Residential Treatment Facility	BH-1982	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BH-1982	OTHER	AZ	SITE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255448833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST BEHAVIORAL HEALTH SERVICES

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

Provider Business Practice Location Address
First Line	:	1424 S 7TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007-3902
Country	:	US
Telephone Number	:	602-257-8970
Fax Number	:	602-462-5941

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	STEVEN SHEETS
Credential	:
Telephone Number	:	602-351-6986

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	11/09/2023

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