Healthcare Provider Details

I. General information

NPI: 1992342265
Provider Name (Legal Business Name): TALAS HARBOR AT BUCKEYE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 S 9TH AVE
PHOENIX AZ
85007-3904
US

IV. Provider business mailing address

1407 S 9TH AVE
PHOENIX AZ
85007-3904
US

V. Phone/Fax

Practice location:
  • Phone: 928-299-5178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RON STEWART
Title or Position: CEO
Credential:
Phone: 253-241-4992