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General NPI Number Information
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NPI Number | 1548491053
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Entity Type | Organization
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Legal Business Name | PANTANO BEHAVIORAL HEALTH SERVICES, INC
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 07/31/2009
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Provider Practice Location Address
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Address Line | 174 S CORONADO DR STE B
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-6356
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Country | US
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Telephone | 520-458-1044
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Fax | 520-458-1192
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Provider Business Mailing Address
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Address Line | 5055 E BROADWAY BLVD STE C104
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City | TUCSON
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State | AZ
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Zip | 85711-3641
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Country | US
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Telephone | 520-623-9833
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Fax | 520-623-9083
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Authorized Official
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Title or Position | CEO
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Name | PATRICIA D TREEFUL
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Credential |
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Telephone | 520-623-9833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | BH3328
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License Number State | AZ
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