Healthcare Provider Details

I. General information

NPI: 1447006663
Provider Name (Legal Business Name): REGENERATION GROVE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8727 S PRIEST DR STE 101
TEMPE AZ
85284-1915
US

IV. Provider business mailing address

8727 S PRIEST DR STE 101
TEMPE AZ
85284-1915
US

V. Phone/Fax

Practice location:
  • Phone: 602-584-2752
  • Fax:
Mailing address:
  • Phone: 602-584-2752
  • Fax: 480-605-2773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: LLEVA GROVES
Title or Position: PMHNP-BC
Credential: PMHNP-BC
Phone: 480-618-0323