Healthcare Provider Details

I. General information

NPI: 1851145809
Provider Name (Legal Business Name): MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5102 W CAMPBELL AVE
PHOENIX AZ
85031-1703
US

IV. Provider business mailing address

PO BOX 29670
PHOENIX AZ
85038-9670
US

V. Phone/Fax

Practice location:
  • Phone: 602-655-1900
  • Fax:
Mailing address:
  • Phone: 602-344-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAMELA S FOWLER
Title or Position: SYSTEM DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 602-344-2830