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General NPI Number Information
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NPI Number | 1790130482
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Entity Type | Organization
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Legal Business Name | MOUNTAIN DEW BEHAVIORAL HEALTH PLC
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Dates
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Enumeration Date | 04/30/2016
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 6700 N ORACLE RD SUITE 119
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City | TUCSON
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State | AZ
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Zip | 85704-7732
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Country | US
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Telephone | 520-389-8468
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Fax |
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Provider Business Mailing Address
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Address Line | 6700 N ORACLE RD
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City | TUCSON
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State | AZ
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Zip | 85704-7732
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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 | CHAIRMAN/MEDICAL DIRECTOR
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Name | DR. JAMES ABANISHE
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Credential | MD
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Telephone | 917-376-7720
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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 | 50979
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License Number State | AZ
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