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General NPI Number Information
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NPI Number | 1760830137
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 611 W UNION ST
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City | BENSON
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State | AZ
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Zip | 85602-6718
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Country | US
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Telephone | 520-586-6177
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Fax |
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Provider Business Mailing Address
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Address Line | 611 W UNION ST
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City | BENSON
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State | AZ
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Zip | 85602-6718
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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 | CONTRACTS & CREDENTIALING ADMIN
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Name | ESTELLA HERNANDEZ
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Credential | MBA
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Telephone | 520-838-5513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | BH4804
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License Number State | AZ
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