Healthcare Provider Details

I. General information

NPI: 1558514067
Provider Name (Legal Business Name): CHOICES NETWORK OF ARIZONA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 S PRIEST DR BLDG 6, STE101
TEMPE AZ
85281-6204
US

IV. Provider business mailing address

3003 N CENTRAL AVE SUITE 300
PHOENIX AZ
85012-2904
US

V. Phone/Fax

Practice location:
  • Phone: 480-929-5100
  • Fax: 480-731-1066
Mailing address:
  • Phone: 602-952-3400
  • Fax: 602-952-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS MCKELVEY
Title or Position: CEO
Credential:
Phone: 602-952-3400