=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528424108
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALOR BEHAVIORAL HEALTHCARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2016
-----------------------------------------------------
Last Update Date | 02/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6613 N SCOTTSDALE RD SUITE 200
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85250-7802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-494-5836
-----------------------------------------------------
Fax | 480-494-5719
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6613 N SCOTTSDALE RD SUITE 200
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85250-7802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-494-5836
-----------------------------------------------------
Fax | 480-494-5719
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARY ELIZABETH SALCEDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-494-5836
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | OTC7537
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | OTC7537
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | OTC7537
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------