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General NPI Number Information
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NPI Number | 1538043443
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Entity Type | Organization
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Legal Business Name | DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 48203 W FARRELL RD
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City | MARICOPA
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State | AZ
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Zip | 85139-3806
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Country | US
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Telephone | 602-581-6080
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Fax | 602-263-1619
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Provider Business Mailing Address
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Address Line | PO BOX 95460
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City | CLEVELAND
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State | OH
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Zip | 44101-0033
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Country | US
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Telephone | 602-581-6080
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Fax | 602-263-1619
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. LAURA TILLMAN
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Credential | MD
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Telephone | 602-263-1674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/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 | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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