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General NPI Number Information
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NPI Number | 1538788575
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Entity Type | Organization
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Legal Business Name | SWEETWATER BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 15778 W CARIBBEAN LN
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City | SURPRISE
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State | AZ
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Zip | 85379-6238
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Country | US
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Telephone | 623-229-5825
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Fax |
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Provider Business Mailing Address
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Address Line | 15778 W CARIBBEAN LN
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City | SURPRISE
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State | AZ
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Zip | 85379-6238
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Country | US
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Telephone | 623-229-5825
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARIA RODARTE
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Credential |
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Telephone | 623-229-5825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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