Healthcare Provider Details

I. General information

NPI: 1164744736
Provider Name (Legal Business Name): AURORA BEHAVIORAL HEALTHCARE - TEMPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 S MAPLE AVE
TEMPE AZ
85283-2857
US

IV. Provider business mailing address

6350 S MAPLE AVE
TEMPE AZ
85283-2857
US

V. Phone/Fax

Practice location:
  • Phone: 480-345-5410
  • Fax: 480-345-5450
Mailing address:
  • Phone: 480-345-5410
  • Fax: 480-345-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberBHSH-3535
License Number StateAZ

VIII. Authorized Official

Name: SOON K KIM
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential:
Phone: 248-905-5091