| Olive Branch Behavioral Residencial Network, Llc | |
|
2421 E Robert E Lee St Phoenix AZ 85032-1082 | |
| (602) 569-0806 | |
| (602) 569-0537 |
| Full Name | Olive Branch Behavioral Residencial Network, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry |
| Location | 2421 E Robert E Lee St, Phoenix, Arizona |
| Authorized Official Name and Position | Tracy Barshell Ketchum (CAO,ADMINISTRATOR) |
| Authorized Official Contact | 7082778673 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Olive Branch Behavioral Residencial Network, Llc 15712 W Eucalyptus Ct Surprise AZ 85374-3308 Ph: (708) 277-8673 | Olive Branch Behavioral Residencial Network, Llc 2421 E Robert E Lee St Phoenix AZ 85032-1082 Ph: (602) 569-0806 |
| NPI Number | 1215574496 |
|---|---|
| Provider Enumeration Date | 12/05/2019 |
| Last Update Date | 12/05/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215574496 | NPI | - | NPPES |
| 1028196670 | Other | AZ | BEHAVIORAL HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | (* (Not Available)) | Primary |
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