Healthcare Provider Details

I. General information

NPI: 1669195806
Provider Name (Legal Business Name): HERITAGE HOUSE BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 E WASHINGTON ST STE 300
PHOENIX AZ
85034-1908
US

IV. Provider business mailing address

4600 E WASHINGTON ST STE 300
PHOENIX AZ
85034-1908
US

V. Phone/Fax

Practice location:
  • Phone: 480-716-3713
  • Fax:
Mailing address:
  • Phone: 480-716-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LENA WRIGHT
Title or Position: OFFICE MANAGER
Credential:
Phone: 586-855-1263