| Centro De Amistad, Incorporado | |
|
460 N Mesa Dr Ste 115 Mesa AZ 85201-5974 | |
| (480) 833-0227 | |
| (480) 655-1382 |
| Full Name | Centro De Amistad, Incorporado |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 460 N Mesa Dr Ste 115, Mesa, Arizona |
| Authorized Official Name and Position | Rita Monroy (PRESIDENT AND CEO) |
| Authorized Official Contact | 6023933840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Centro De Amistad, Incorporado 2923 N 33rd Ave Phoenix AZ 85017-5201 Ph: (602) 393-3840 | Centro De Amistad, Incorporado 460 N Mesa Dr Ste 115 Mesa AZ 85201-5974 Ph: (480) 833-0227 |
| NPI Number | 1073684791 |
|---|---|
| Provider Enumeration Date | 11/13/2006 |
| Last Update Date | 03/08/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073684791 | NPI | - | NPPES |
| 1062003 | Other | AZ | VO BILLING NUMBER |
| 116906 | Other | AZ | AHCCCS PROVIDER # |
| A000173 | Other | AZ | MHS VENDOR NO. |
| BH-2632 | Other | AZ | AZ BH LICENSE NO |
| 600252351 | Other | AZ | MAGELLAN MIS# |
| BH-3610 | Other | AZ | AZ BH LINENCE # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | BH-2632 (Arizona) | Primary |
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