Healthcare Provider Details

I. General information

NPI: 1932348240
Provider Name (Legal Business Name): SOUTHWEST BEHAVIORAL HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 W BROADWAY AVE SUITE 1 & 2
APACHE JUNCTION AZ
85220-7658
US

IV. Provider business mailing address

3450 N 3RD ST
PHOENIX AZ
85012-2331
US

V. Phone/Fax

Practice location:
  • Phone: 480-671-3032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberBH-3172
License Number StateAZ

VIII. Authorized Official

Name: MR. JEFF JORDE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 602-285-4285