MEDICARE: CARE LEVEL MANAGEMENT ARIZONA, INC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1578677993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE LEVEL MANAGEMENT ARIZONA, INC

Provider Business Mailing Address
First Line	:	5700 CANOGA AVE
Second Line	:	SUITE 500
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6579
Country	:	US
Telephone Number	:	800-377-3606
Fax Number	:	818-595-8206

Provider Business Practice Location Address
First Line	:	2525 E CAMELBACK RD
Second Line	:	SUITE 940
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4219
Country	:	US
Telephone Number	:	800-829-8133
Fax Number	:	818-595-8206

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	RICHARD ST.ANDREW
Credential	:
Telephone Number	:	818-595-8180

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	08/22/2020

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