Healthcare Provider Details

I. General information

NPI: 1124794466
Provider Name (Legal Business Name): ALTRU HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W BERYL AVE STE 302
PHOENIX AZ
85021-1606
US

IV. Provider business mailing address

2525 W BERYL AVE STE 302
PHOENIX AZ
85021-1606
US

V. Phone/Fax

Practice location:
  • Phone: 702-703-9666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY PHELPS
Title or Position: OWNER
Credential:
Phone: 702-703-9666