Healthcare Provider Details

I. General information

NPI: 1326888306
Provider Name (Legal Business Name): PARADISE BEHAVIORAL HEALTH, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 W BEHREND DR STE 3
PHOENIX AZ
85027-4406
US

IV. Provider business mailing address

960 W BEHREND DR STE 3
PHOENIX AZ
85027-4406
US

V. Phone/Fax

Practice location:
  • Phone: 623-434-6567
  • Fax: 623-434-6779
Mailing address:
  • Phone: 623-434-6567
  • Fax: 623-434-6779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BIBI MOHAMMED
Title or Position: CEO
Credential:
Phone: 623-434-6567