Healthcare Provider Details

I. General information

NPI: 1114715356
Provider Name (Legal Business Name): DIGNITY HEALTH BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 S 13TH PL
PHOENIX AZ
85042-5818
US

IV. Provider business mailing address

6911 S 13TH PL
PHOENIX AZ
85042-5818
US

V. Phone/Fax

Practice location:
  • Phone: 602-975-8528
  • Fax: 480-546-3626
Mailing address:
  • Phone: 602-975-8528
  • Fax: 480-546-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: NELLIE NJUE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 480-980-9729