Healthcare Provider Details

I. General information

NPI: 1376276360
Provider Name (Legal Business Name): ULTIMATE PHYSICAL AND MENTAL HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13350 N 94TH DR STE B102
PEORIA AZ
85381-4826
US

IV. Provider business mailing address

16336 W MORELAND ST
GOODYEAR AZ
85338-6291
US

V. Phone/Fax

Practice location:
  • Phone: 310-956-0556
  • Fax:
Mailing address:
  • Phone: 623-213-7135
  • Fax: 623-213-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PATIENCE RONKE AKHIMIEN
Title or Position: CEO
Credential: DNP
Phone: 310-956-0556