Healthcare Provider Details

I. General information

NPI: 1023190618
Provider Name (Legal Business Name): SPRINGBROOK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 E CACTUS RD SUITE 460
SCOTTSDALE AZ
85254-4191
US

IV. Provider business mailing address

4835 E CACTUS RD SUITE 460
SCOTTSDALE AZ
85254-4191
US

V. Phone/Fax

Practice location:
  • Phone: 602-424-1838
  • Fax: 602-424-7879
Mailing address:
  • Phone: 602-424-1838
  • Fax: 602-424-7879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH-2868
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberBH-2372
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberBH-3021
License Number StateAZ

VIII. Authorized Official

Name: MR. GEORGE W GREEN JR.
Title or Position: CLINICAL DIRECTOR
Credential: M.ED.
Phone: 602-424-1838