Healthcare Provider Details

I. General information

NPI: 1255881579
Provider Name (Legal Business Name): EMPACT - SUICIDE PREVENTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11518 E APACHE TRL #129
APACHE JUNCTION AZ
85120-3551
US

IV. Provider business mailing address

618 S MADISON DR
TEMPE AZ
85281-7248
US

V. Phone/Fax

Practice location:
  • Phone: 480-784-1514
  • Fax: 480-967-3528
Mailing address:
  • Phone: 480-784-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateAZ

VIII. Authorized Official

Name: MS. ERICA CHESTNUT-RAMIREZ
Title or Position: REGIONAL VICE PRESIDENT
Credential: MC, LIAC
Phone: 480-784-1514