MEDICARE: KADELYX HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1366247298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KADELYX HEALTH LLC

Provider Business Mailing Address
First Line	:	3601 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-6023
Country	:	US
Telephone Number	:	602-206-4980
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-6023
Country	:	US
Telephone Number	:	602-206-4980
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	QUINN SNYDER
Credential	:	MD
Telephone Number	:	520-271-7370

Provider Enumeration Date	:	02/14/2025
Last Update Date	:	02/17/2025

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Directions to “KADELYX HEALTH LLC ” Practice Location

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