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General NPI Number Information
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NPI Number | 1124713995
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Entity Type | Organization
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Legal Business Name | AXEL BEHAVIORAL HEALTH SYSTEM LLC
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Dates
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Enumeration Date | 04/07/2023
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 20148 N DONITHAN WAY
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City | MARICOPA
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State | AZ
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Zip | 85138-2428
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Country | US
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Telephone | 480-516-8103
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Fax |
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Provider Business Mailing Address
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Address Line | 20148 N DONITHAN WAY
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City | MARICOPA
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State | AZ
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Zip | 85138-2428
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Country | US
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Telephone | 480-516-8103
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CARLSON TAMINANG
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Credential | RN
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Telephone | 480-516-8103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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