MEDICARE: ARIZONA BAPTIST CHILDREN'S SERVICES

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	BH2784	AZ
2	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	BH1340	AZ
3	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	BH2681	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	044678	OTHER	AZ	AHCCCS PROVIDER ID NO
2	011411	OTHER	AZ	AHCCCS PROVIDER ID NO.
3	1020012	OTHER	AZ	ADHS PROVIDER ID NO
4	117284	OTHER	AZ	AHCCCS PROVIDER ID NO.
5	1020005	OTHER	AZ	ADHS PROVIDER ID NO.
6	1020010	OTHER	AZ	ADHS PROVIDER ID NO.

General Provider Information

NPI Number	:	1407957467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA BAPTIST CHILDREN'S SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 35637
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85069-5637
Country	:	US
Telephone Number	:	602-346-2300
Fax Number	:	602-346-2399

Provider Business Practice Location Address
First Line	:	1717 W NORTHERN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5469
Country	:	US
Telephone Number	:	602-346-2300
Fax Number	:	602-346-2399

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	MR. DON E. MCDANIEL JR.
Credential	:
Telephone Number	:	602-346-2319

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/22/2020

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Directions to “ARIZONA BAPTIST CHILDREN'S SERVICES ” Practice Location

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