Basic Information
| Provider Information | |||||||||
| NPI: | 1376623769 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA BEHAVIORAL HOME HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4225 W GLENDALE AVE | ||||||||
| Address2: | SUITE E119 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850518194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239150270 | ||||||||
| FaxNumber: | 6239150280 | ||||||||
| Practice Location | |||||||||
| Address1: | 1349 E COLTER ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850143048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239150270 | ||||||||
| FaxNumber: | 6239150280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 12/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | BONNACCI | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6239150270 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | 3376 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No ID Information.