PROVIDENCE OF ARIZONA INC. NPI 1588764427

NPI Information

NPI: 1588764427
Provider Name: PROVIDENCE OF ARIZONA, INC.

Other Name: PROVIDENCIA

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
3602 W THOMAS RD
PHOENIX, AZ
ZIP 85019
Phone: (602) 455-4626
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PROVIDENCE OF ARIZONA, INC. is a mental health (including community mental health center) clinic center in Phoenix, AZ. PROVIDENCE OF ARIZONA, INC. NPI is 1588764427. The provider is registered as an organization entity type.
The provider Other Name Is Providencia.

The provider's business location address is:

3602 W THOMAS RD
PHOENIX, AZ
ZIP 85019-442
Phone: (602) 455-4626
Fax: (602) 455-4624

The provider's authorized official is David Hedgcock .
The authorized official title is Executive Director and has the following contact phone number (602) 455-4626.

The enumeration date for this NPI number is 9/22/2006 and was last updated on 8/22/2020.

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
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	BH-2200	ARIZONA	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	796021	MEDICAID	ARIZONA

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

NPI Synchronization or Removal

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