Healthcare Provider Details

I. General information

NPI: 1184372286
Provider Name (Legal Business Name): NUPHASE HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 W GLENDALE AVE STE A102
PHOENIX AZ
85051-8195
US

IV. Provider business mailing address

14613 E DESERT VISTA TRL
SCOTTSDALE AZ
85262-7826
US

V. Phone/Fax

Practice location:
  • Phone: 717-747-6522
  • Fax:
Mailing address:
  • Phone: 717-747-6522
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANA FLOYD
Title or Position: CHIEF ORGANIZING OFFICER
Credential:
Phone: 202-999-8094