Healthcare Provider Details

I. General information

NPI: 1669002903
Provider Name (Legal Business Name): SUMMIT BEHAVIORAL HEALTH OF ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8183 E FLORENTINE RD
PRESCOTT VALLEY AZ
86314-8481
US

IV. Provider business mailing address

8183 E FLORENTINE RD
PRESCOTT VALLEY AZ
86314-8481
US

V. Phone/Fax

Practice location:
  • Phone: 928-756-0694
  • Fax:
Mailing address:
  • Phone: 928-756-0694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN T ISENBERG
Title or Position: CEO
Credential:
Phone: 928-710-7021