Provider Demographics
NPI:1548491350
Name:ARIZONA BEHAVIORAL HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:ARIZONA BEHAVIORAL HOME HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:MILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-264-2770
Mailing Address - Street 1:4620 N 16TH ST
Mailing Address - Street 2:E-110
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5121
Mailing Address - Country:US
Mailing Address - Phone:602-264-2770
Mailing Address - Fax:866-534-1701
Practice Address - Street 1:4620 N 16TH ST
Practice Address - Street 2:E-110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5121
Practice Address - Country:US
Practice Address - Phone:602-264-2770
Practice Address - Fax:866-534-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3376103TB0200X
AZBH-3188251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH-3188OtherOBHL LICENSE
AZ703307Medicaid
AZ703307Medicaid