Provider Demographics
| NPI: | 1144799792 |
|---|---|
| Name: | GENHEALTH |
| Entity type: | Organization |
| Organization Name: | GENHEALTH |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | DAVID |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | ROSS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PHARMD |
| Authorized Official - Phone: | 480-559-5260 |
| Mailing Address - Street 1: | 14441 W MCDOWELL RD STE B102 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | GOODYEAR |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85395-2519 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 480-516-8037 |
| Mailing Address - Fax: | 480-400-4383 |
| Practice Address - Street 1: | 14441 W MCDOWELL RD STE B102 |
| Practice Address - Street 2: | |
| Practice Address - City: | GOODYEAR |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85395-2519 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 480-516-8037 |
| Practice Address - Fax: | 480-400-4383 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2018-11-13 |
| Last Update Date: | 2025-02-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | Group - Multi-Specialty | |
| No | 183500000X | Pharmacy Service Providers | Pharmacist | Group - Multi-Specialty | |
| No | 2084P0802X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AZ | 729400 | Medicaid |
