Healthcare Provider Details

I. General information

NPI: 1750736724
Provider Name (Legal Business Name): DESERT SAGE BEHAVIORAL HEALTH, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7090 N ORACLE RD SUITE 178-203
TUCSON AZ
85704-4333
US

IV. Provider business mailing address

7090 N ORACLE RD SUITE 178-203
TUCSON AZ
85704-4333
US

V. Phone/Fax

Practice location:
  • Phone: 866-213-0445
  • Fax: 866-531-9559
Mailing address:
  • Phone: 866-213-0445
  • Fax: 866-531-9559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN103631
License Number StateAZ

VIII. Authorized Official

Name: DANIEL CHAFETZ
Title or Position: OWNER
Credential: NP
Phone: 866-213-0445