MEDICARE: SOUTHWEST BEHAVIORAL HEALTH

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	320800000X	Mental Illness Community Based Residential Treatment Facility	BH-2104	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376550343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	3450 N 3RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2331
Country	:	US
Telephone Number	:	602-257-9339
Fax Number	:	602-265-8574

Provider Business Practice Location Address
First Line	:	2042 N 35TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85009-2353
Country	:	US
Telephone Number	:	602-272-5250
Fax Number	:	602-272-4199

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	MR. JEFF JORDE
Credential	:
Telephone Number	:	602-285-4285

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	08/22/2020

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Directions to “SOUTHWEST BEHAVIORAL HEALTH ” Practice Location

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