Healthcare Provider Details

I. General information

NPI: 1558201897
Provider Name (Legal Business Name): GIBRALTAR PSYCHIATRIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W IRON AVE STE 204
MESA AZ
85210-6027
US

IV. Provider business mailing address

540 W IRON AVE STE 204
MESA AZ
85210-6027
US

V. Phone/Fax

Practice location:
  • Phone: 623-210-2080
  • Fax:
Mailing address:
  • Phone: 623-210-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. EWARYST JEDRASIK
Title or Position: CEO
Credential: RN
Phone: 623-210-2080