Healthcare Provider Details

I. General information

NPI: 1316785603
Provider Name (Legal Business Name): SAMARIA BEHAVIORAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 08/25/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6197 S RURAL RD
TEMPE AZ
85283-2909
US

IV. Provider business mailing address

6197 S RURAL RD
TEMPE AZ
85283-2909
US

V. Phone/Fax

Practice location:
  • Phone: 480-471-8980
  • Fax: 480-912-1061
Mailing address:
  • Phone: 480-471-8980
  • Fax: 480-912-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. DAPHNE A LOUISSAINT
Title or Position: OWNER
Credential:
Phone: 480-842-5138