MEDICARE: SOLUTION BEHAVIORAL 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	320800000X	Mental Illness Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BH7382	OTHER	AZ	AZDHS

General Provider Information

NPI Number	:	1588314579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLUTION BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	1904 W HAZELWOOD PKWY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-4105
Country	:	US
Telephone Number	:	602-459-5926
Fax Number	:

Provider Business Practice Location Address
First Line	:	6349 W RAYMOND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-0135
Country	:	US
Telephone Number	:	602-459-5926
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NELLY KANYANGE
Credential	:
Telephone Number	:	602-459-5926

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/24/2022

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