MEDICARE: NEW HAVEN BEHAVIORAL HEALTH LLC

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	:	1538870910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HAVEN BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	2406 S 24TH ST STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-6863
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 S 24TH ST STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-6863
Country	:	US
Telephone Number	:	602-690-2240
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	RODERICK COFFMAN
Credential	:
Telephone Number	:	602-690-2240

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	12/07/2022

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