DESERT BOLT BEHAVIORAL LLC NPI 1649897414

NPI Information

NPI: 1649897414
Provider Name: DESERT BOLT BEHAVIORAL LLC

Former Legal Business Name: DESERT BOLT BEHAVIORAL LLC

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

Specialization: Mental Health (Including Community Mental Health Center)

Address:
42201 N 41ST DR STE 160
ANTHEM, AZ
ZIP 85086
Phone: (850) 527-0042
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DESERT BOLT BEHAVIORAL LLC is a mental health (including community mental health center) clinic center in Anthem, AZ. DESERT BOLT BEHAVIORAL LLC NPI is 1649897414. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Desert Bolt Behavioral Llc.

The provider's business location address is:

42201 N 41ST DR STE 160
ANTHEM, AZ
ZIP 85086-803
Phone: (850) 527-0042
Fax: (480) 296-0002

The provider's authorized official is Valery A Nkendong .
The authorized official title is Ceo and has the following contact phone number (480) 527-0042.

The enumeration date for this NPI number is 6/28/2020 and was last updated on 7/5/2021.

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)			Yes
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health			No

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	120200727001036	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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