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2615 E Beverly Ave Kingman AZ 86409-3631 | |
| (602) 253-1240 | |
| (602) 253-1250 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2615 E Beverly Ave, Kingman, Arizona |
| Authorized Official Name and Position | Jeff Kazmierczak (CEO) |
| Authorized Official Contact | 4804144879 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7816 N 19th Ave Phoenix AZ 85021-7036 Ph: (602) 253-1240 | 2615 E Beverly Ave Kingman AZ 86409-3631 Ph: (602) 253-1240 |
| NPI Number | 1851735369 |
|---|---|
| Provider Enumeration Date | 04/26/2013 |
| Last Update Date | 08/14/2024 |
| Certification Date | 08/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851735369 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | OTC7588 (Arizona) | Primary |
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