| Makini Mental Health Center Llc | |
|
8805 N 23rd Ave Ste 100 Phoenix AZ 85021-4172 | |
| (602) 856-6116 | |
| (602) 856-6122 |
| Full Name | Makini Mental Health Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 8805 N 23rd Ave Ste 100, Phoenix, Arizona |
| Authorized Official Name and Position | Stanley Kidiavayi (PROVIDER) |
| Authorized Official Contact | 6028566116 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Makini Mental Health Center Llc 8805 N 23rd Ave Ste 100 Phoenix AZ 85021-4172 Ph: (602) 856-6116 | Makini Mental Health Center Llc 8805 N 23rd Ave Ste 100 Phoenix AZ 85021-4172 Ph: (602) 856-6116 |
| NPI Number | 1386350049 |
|---|---|
| Provider Enumeration Date | 01/26/2023 |
| Last Update Date | 09/11/2024 |
| Certification Date | 09/11/2024 |
| Medicare PECOS PAC ID | 9133594013 |
|---|---|
| Medicare Enrollment ID | O20230406000631 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386350049 | NPI | - | NPPES |
| Provider Name | Fatima Tagle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033201405 PECOS PAC ID: 0143277392 Enrollment ID: I20110302000796 |
| Provider Name | Gresheene Dea Kuhn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578013652 PECOS PAC ID: 6002191780 Enrollment ID: I20170320001574 |
| Provider Name | Stanley Kidiavayi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902290968 PECOS PAC ID: 7416259551 Enrollment ID: I20230411000294 |
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