IDEAL TREATMENT CENTER LLC NPI 1336837616

NPI Information

  • NPI: 1336837616
  • Provider Name: IDEAL TREATMENT CENTER LLC
  • Classification: Clinic/Center - 261QM0801X
  • Specialization: Mental Health (Including Community Mental Health Center)
  • Entity Type: Organization
  • CLIA Number: 03D2319779
  • Address: 1717 W NORTHERN AVE STE 107
    PHOENIX, AZ
    ZIP 85021
  • Phone: (602) 612-2305

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NPI Details

IDEAL TREATMENT CENTER LLC is a mental health (including community mental health center) clinic center in Phoenix, AZ. IDEAL TREATMENT CENTER LLC NPI is 1336837616. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1717 W NORTHERN AVE STE 107
PHOENIX, AZ
ZIP 85021-400
Phone: (602) 612-2305

The provider's authorized official is Aimee Uwimana .
The authorized official title is Nurse Practitioner and has the following contact phone number (602) 399-0134.

The CLIA number assigned to this NPI record is 03D2319779 - comp. outpatient rehab facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/25/2023 and was last updated on 6/4/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YA0400XCounselorAddiction (Substance Use Disorder)No
2101YM0800XCounselorMental HealthNo
3163WP0808XRegistered NursePsychiatric/Mental HealthNo
4251B00000XCase ManagementNo
5261Q00000XClinic/CenterNo
6261QM0850XClinic/CenterAdult Mental HealthNo
7261QM1300XClinic/CenterMulti-SpecialtyNo
8261QP2300XClinic/CenterPrimary CareNo
9261QR0405XClinic/CenterRehabilitation, Substance Use DisorderNo
10363LP0808XNurse PractitionerPsychiatric/Mental HealthNo
11363LP2300XNurse PractitionerPrimary CareNo
12261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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