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General NPI Number Information
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NPI Number | 1760017099
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Entity Type | Organization
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Legal Business Name | PHOENIX MEDICAL PSYCHIATRIC HOSPITAL, LLC
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Dates
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Enumeration Date | 03/06/2020
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 1346 MCDOWELL ROAD
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City | PHOENIX
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State | AZ
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Zip | 85006
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Country | US
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Telephone | 833-312-0320
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Fax |
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Provider Business Mailing Address
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Address Line | 112 W JEFFERSON BLVD STE 600
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City | SOUTH BEND
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State | IN
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Zip | 46601-1921
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Country | US
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Telephone | 574-277-2630
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Fax | 574-277-2635
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Authorized Official
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Title or Position | CORP BOD
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Name | CHRISTY KELTNER
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Credential |
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Telephone | 615-319-6552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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