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General NPI Number Information
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NPI Number | 1609229574
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Entity Type | Organization
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Legal Business Name | PASADERA BEHAVIORAL HEALTH NETWORK, INC.
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | 2502 N DODGE BLVD STE 190
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City | TUCSON
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State | AZ
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Zip | 85716-2675
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Country | US
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Telephone | 520-628-3400
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Fax | 520-628-3151
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Provider Business Mailing Address
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Address Line | 2700 S 8TH AVE
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City | TUCSON
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State | AZ
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Zip | 85713-4730
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Country | US
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Telephone | 520-628-3400
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Fax |
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Authorized Official
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Title or Position | CONTRACTS, COMPLIANCE MANAGER
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Name | ANDREA R CANCHOLA
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Credential | BS
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Telephone | 520-628-3450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | BH-4798
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License Number State | AZ
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