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General NPI Number Information
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NPI Number | 1518451251
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 06/17/2018
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Last Update Date | 06/17/2018
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Provider Practice Location Address
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Address Line | 9417 N 17TH PL
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City | PHOENIX
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State | AZ
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Zip | 85020-2310
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Country | US
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Telephone | 520-661-2594
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Fax |
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Provider Business Mailing Address
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Address Line | 9417 N 17TH PL
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City | PHOENIX
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State | AZ
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Zip | 85020-2310
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Country | US
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Telephone | 520-661-2594
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Fax |
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Authorized Official
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Title or Position | PROGRAM ADMINISTRATOR
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Name | MR. ANTHONY RAY DIQUARTO
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Credential | BA
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Telephone | 775-233-5082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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