Healthcare Provider Details

I. General information

NPI: 1134549579
Provider Name (Legal Business Name): PRIDE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 12/18/2022
Certification Date: 12/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 S GILBERT RD STE 109
CHANDLER AZ
85249-6023
US

IV. Provider business mailing address

4960 S GILBERT RD STE 109
CHANDLER AZ
85249-6023
US

V. Phone/Fax

Practice location:
  • Phone: 928-326-6082
  • Fax: 866-812-0853
Mailing address:
  • Phone: 928-326-6082
  • Fax: 866-812-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MISS REBECCA L JAMES
Title or Position: CEO
Credential: PNP-BC
Phone: 602-326-9135