Healthcare Provider Details

I. General information

NPI: 1598482119
Provider Name (Legal Business Name): SENTINEL HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W NORTHERN AVE ST 202 F
PHOENIX AZ
85021-5471
US

IV. Provider business mailing address

1717 W NORTHERN AVENUE ST 202F
PHOENIX AZ
85021
US

V. Phone/Fax

Practice location:
  • Phone: 480-674-9259
  • Fax:
Mailing address:
  • Phone: 480-276-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK MASOYA
Title or Position: SITE ADMINISTRATOR/AUTHORIZED PERSO
Credential:
Phone: 480-276-8277