Healthcare Provider Details

I. General information

NPI: 1932274214
Provider Name (Legal Business Name): DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10005 E OSBORN RD
SCOTTSDALE AZ
85256-4019
US

IV. Provider business mailing address

PO BOX 31001-0698
PASADENA CA
91110-0698
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-1200
  • Fax: 602-263-1618
Mailing address:
  • Phone: 602-263-1200
  • Fax: 602-263-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MISS DEANNA J. DICK
Title or Position: (CEO) CHIEF EXECUTIVE OFFICER
Credential: MSW., MHA.
Phone: 602-263-1567