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General NPI Number Information
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NPI Number | 1316785603
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Entity Type | Organization
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Legal Business Name | SAMARIA BEHAVIORAL HEALTH CENTER LLC
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Dates
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Enumeration Date | 07/19/2024
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Last Update Date | 08/25/2024
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Provider Practice Location Address
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Address Line | 6197 S RURAL RD
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City | TEMPE
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State | AZ
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Zip | 85283-2909
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Country | US
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Telephone | 480-471-8980
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Fax | 480-912-1061
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Provider Business Mailing Address
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Address Line | 6197 S RURAL RD
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City | TEMPE
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State | AZ
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Zip | 85283-2909
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Country | US
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Telephone | 480-471-8980
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Fax | 480-912-1061
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DAPHNE A LOUISSAINT
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Credential |
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Telephone | 480-842-5138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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