MEDICARE: VANGUARD 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1629716279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANGUARD BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	7211 S HILDRETH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85746-9614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7211 S HILDRETH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85746-9614
Country	:	US
Telephone Number	:	480-320-0752
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LAWRENCE BRIGGS
Credential	:
Telephone Number	:	480-320-0752

Provider Enumeration Date	:	05/24/2022
Last Update Date	:	05/31/2023

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