Healthcare Provider Details

I. General information

NPI: 1093500670
Provider Name (Legal Business Name): CACTUS SERENITY BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 W UNION HILLS DR
GLENDALE AZ
85308-2429
US

IV. Provider business mailing address

3515 W UNION HILLS DR STE 114B
GLENDALE AZ
85308-2431
US

V. Phone/Fax

Practice location:
  • Phone: 602-612-3124
  • Fax:
Mailing address:
  • Phone: 602-612-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. BEATRICE EKO
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-612-3124