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General NPI Number Information
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NPI Number | 1699576066
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Entity Type | Organization
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Legal Business Name | CONVERGENCE HEALTH LLC
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 5601 HIGHWAY 95 N STE 714
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86404-8551
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Country | US
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Telephone | 928-538-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 5601 HIGHWAY 95 N STE 714
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86404-8551
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Country | US
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Telephone | 928-538-4325
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Fax |
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Authorized Official
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Title or Position | CNO/ADMINISTRATOR
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Name | COURTNEY STANSBURY
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Credential |
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Telephone | 928-538-4325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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