Healthcare Provider Details

I. General information

NPI: 1275861007
Provider Name (Legal Business Name): MHCTI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3771 E BROOKS FARMS RD
GILBERT AZ
85298-5811
US

IV. Provider business mailing address

23844 S POWER RD SUITE 102-115
QUEEN CREEK AZ
85142-6152
US

V. Phone/Fax

Practice location:
  • Phone: 480-988-3376
  • Fax: 480-988-4371
Mailing address:
  • Phone: 480-988-3376
  • Fax: 480-988-4371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License NumberBH 2607
License Number StateAZ

VIII. Authorized Official

Name: MR. GEORGE MILLER
Title or Position: ADMINISTRATOR/ MANAGER
Credential:
Phone: 480-988-3376