Healthcare Provider Details

I. General information

NPI: 1114871258
Provider Name (Legal Business Name): ARIZONA INTEGRATED CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15015 W BELL RD STE 102
SURPRISE AZ
85374-3248
US

IV. Provider business mailing address

14037 N 153RD DR
SURPRISE AZ
85379-8038
US

V. Phone/Fax

Practice location:
  • Phone: 678-661-1266
  • Fax:
Mailing address:
  • Phone: 623-299-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: JEREMY LAWRENCE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 678-661-1266