Healthcare Provider Details

I. General information

NPI: 1104331115
Provider Name (Legal Business Name): MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E MAIN ST
MESA AZ
85203-8820
US

IV. Provider business mailing address

PO BOX 29670
PHOENIX AZ
85038-9670
US

V. Phone/Fax

Practice location:
  • Phone: 602-655-6260
  • Fax:
Mailing address:
  • Phone: 602-344-8178
  • Fax: 602-344-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberH3673
License Number StateAZ

VIII. Authorized Official

Name: CLAIRE AGNEW
Title or Position: CFO
Credential:
Phone: 602-344-8428