Healthcare Provider Details

I. General information

NPI: 1497673487
Provider Name (Legal Business Name): PRIMARY CARE COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 N 27TH AVE STE 5
PHOENIX AZ
85017-1764
US

IV. Provider business mailing address

6025 N 27TH AVE STE 5
PHOENIX AZ
85017-1764
US

V. Phone/Fax

Practice location:
  • Phone: 623-385-9485
  • Fax:
Mailing address:
  • Phone: 623-385-9485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDRE DREVAL
Title or Position: OWNER
Credential:
Phone: 602-706-7998