Healthcare Provider Details

I. General information

NPI: 1023704954
Provider Name (Legal Business Name): BLUE BELL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E 1ST ST
CASA GRANDE AZ
85122-5201
US

IV. Provider business mailing address

2487 S GILBERT RD STE 106-163
GILBERT AZ
85295-2808
US

V. Phone/Fax

Practice location:
  • Phone: 520-375-2682
  • Fax:
Mailing address:
  • Phone: 520-375-2682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LISA TAPIA
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 520-375-2682