=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750405049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAGELLAN HEALTH SERVICES OF ARIZONA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 10/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3450 N HIGLEY RD
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85215-9702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-981-7735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4129 EAST VAN BUREN STREET SUITE 150
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-654-5465
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MS. CHRIS ADAIR CARSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 602-797-8333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | BH2965
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------