MEDICARE: VALLEY SPRING 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1780367185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY SPRING BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	599 MARINA BLVD STE A
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-5477
Country	:	US
Telephone Number	:	480-206-8584
Fax Number	:	602-854-7290

Provider Business Practice Location Address
First Line	:	599 MARINA BLVD STE A
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-5477
Country	:	US
Telephone Number	:	480-206-8584
Fax Number	:	602-854-7290

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PATRICIA WANJA MUTHONI
Credential	:
Telephone Number	:	480-206-8584

Provider Enumeration Date	:	08/11/2023
Last Update Date	:	03/07/2024

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