Healthcare Provider Details

I. General information

NPI: 1912780313
Provider Name (Legal Business Name): TANDEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 E SANTA ROSA DR
GILBERT AZ
85234-1448
US

IV. Provider business mailing address

2970 E SANTA ROSA DR
GILBERT AZ
85234-1448
US

V. Phone/Fax

Practice location:
  • Phone: 469-247-1824
  • Fax:
Mailing address:
  • Phone: 469-247-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: PAUL MUTABARUKA
Title or Position: DIRECTOR
Credential:
Phone: 469-247-1824