Healthcare Provider Details

I. General information

NPI: 1306870910
Provider Name (Legal Business Name): ST LUKES BEHAVIORAL HOSPITAL LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E VAN BUREN ST
PHOENIX AZ
85006-3742
US

IV. Provider business mailing address

1800 E VAN BUREN ST ATTN: BILLING
PHOENIX AZ
85006-3742
US

V. Phone/Fax

Practice location:
  • Phone: 602-251-8642
  • Fax: 602-251-8215
Mailing address:
  • Phone: 602-251-8535
  • Fax: 602-251-8707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: GREGORY L. JAHN
Title or Position: HOSPITAL CEO
Credential:
Phone: 602-251-8546