Provider Demographics
NPI:1144898156
Name:BOE
Entity type:Organization
Organization Name:BOE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-434-1289
Mailing Address - Street 1:15410 N 2ND PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3043
Mailing Address - Country:US
Mailing Address - Phone:602-434-1289
Mailing Address - Fax:
Practice Address - Street 1:20625 N 18TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3540
Practice Address - Country:US
Practice Address - Phone:602-918-5953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder