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General NPI Number Information
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NPI Number | 1639941537
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Entity Type | Organization
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Legal Business Name | BUCKHORN TREATMENT CENTER AT SOUTH MOUNTAIN
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 8222 S 48TH ST
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City | PHOENIX
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State | AZ
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Zip | 85044-5364
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Country | US
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Telephone | 480-293-4327
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Fax |
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Provider Business Mailing Address
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Address Line | 8006 S 38TH PL
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City | PHOENIX
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State | AZ
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Zip | 85042-9621
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | MICHAEL JOHNSON JR.
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Credential |
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Telephone | 480-293-4327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health 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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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