Healthcare Provider Details

I. General information

NPI: 1164221115
Provider Name (Legal Business Name): PHOENIX STAR BEHAVIORAL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W TAMARACK DR
SAN TAN VALLEY AZ
85140-7073
US

IV. Provider business mailing address

28068 N ADRENALINE AVE
SAN TAN VALLEY AZ
85143-6467
US

V. Phone/Fax

Practice location:
  • Phone: 480-202-1674
  • Fax:
Mailing address:
  • Phone: 602-341-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: ANEIKA FALCONER
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 602-341-0123