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SAGE MEMORIAL HOSPITAL BEHAVIORAL HEALTH CLINIC NPI 1407026651


NPI Information

NPI: 1407026651
Provider Name: SAGE MEMORIAL HOSPITAL BEHAVIORAL HEALTH CLINIC
Classification: Social Worker - 104100000X
Entity Type: Organization

CLIA Number: 03D0057991

Address:
HIGHWAY 264 AND 191
SALSBURY HALL SAGE MEMORIAL HOSPITAL CAMPUS
GANADO, AZ
ZIP 86505
Phone: (928) 755-4500
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SAGE MEMORIAL HOSPITAL BEHAVIORAL HEALTH CLINIC is a social worker in Ganado, AZ. The provider is a social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public. SAGE MEMORIAL HOSPITAL BEHAVIORAL HEALTH CLINIC NPI is 1407026651. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

HIGHWAY 264 AND 191
SALSBURY HALL SAGE MEMORIAL HOSPITAL CAMPUS
GANADO, AZ
ZIP 86505
Phone: (928) 755-4500
Fax: (928) 755-4747

The provider's authorized official is Ahmad R. Razaghi .
The authorized official title is Ceo and has the following contact phone number (928) 755-4500.

The CLIA number assigned to this NPI record is 03D0057991 - hospital with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 3/4/2008 and was last updated on 3/4/2008.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101Y00000XCounselor5168TARIZONANo
2101Y00000XCounselor13084ARIZONANo
3104100000XSocial Worker11643ARIZONAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1942757MEDICAIDARIZONA

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: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.