Healthcare Provider Details

I. General information

NPI: 1770506024
Provider Name (Legal Business Name): AURORA BEHAVIORAL HEALTH SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 W PEORIA AVE
GLENDALE AZ
85302-1207
US

IV. Provider business mailing address

6015 W PEORIA AVE
GLENDALE AZ
85302-1207
US

V. Phone/Fax

Practice location:
  • Phone: 623-344-4400
  • Fax: 623-344-4450
Mailing address:
  • Phone: 623-344-4400
  • Fax: 623-344-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberL 12260916
License Number StateAZ

VIII. Authorized Official

Name: SOON K KIM
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential:
Phone: 248-905-5091